Key result
Echocardiography-guided hemodynamic management significantly reduced 30-day mortality to 14.3% compared to 35.6% with early goal-directed therapy in adults with severe sepsis and septic shock.
Why the study?
Echocardiography is used to guide septic shock resuscitation without evidence for efficacy, prompting a comparison between early goal-directed therapy and echocardiography-guided hemodynamic management.
Does echocardiography-guided hemodynamic management reduce mortality compared to early goal-directed therapy in adult patients with severe sepsis and septic shock?
RCT (n=100)
Computer generated sequence through sealed opaque envelopes
No
Does echocardiography-guided hemodynamic management reduce mortality compared to early goal-directed therapy in adult patients with severe sepsis and septic shock?
Hazard Ratio: 1.63 (95% CI 1.123–2.366)
Absolute Event Rate: 14.3% vs 35.6%
p-value: p=0.023
Echocardiography-guided hemodynamic management in severe sepsis and septic shock significantly reduces 30-day mortality, fluid requirements, and ICU length of stay compared to standard early goal-directed therapy.
Supports echocardiography-guided management over EGDT in septic shock; challenges protocolized care and extends individualized resuscitation evidence.
Background: Echocardiography (ECHO) is used to guide septic shock resuscitation, but without evidence for efficacy. Therefore, we compared the outcome of early goal-directed therapy (EGDT) and ECHO-guided management of hemodynamics in severe sepsis and septic shock. Methodology: This was a single center, randomized controlled trial conducted on 100 adult patients with severe sepsis or septic shock. Patients were assessed and treated with either EGDT protocol (Group I - EGDT group) or ECHO-guided resuscitation protocol (Group II - ECHO group). Results: Only 87 patients (45 in Group I and 42 in Group II) were analyzed. There was a significant increase of mean norepinephrine and dobutamine use and a significant decrease in total fluids needed in the first 24 h, time to normalization, time to weaning of vasopressors, total mechanical ventilation (MV) days, MV free days and ICU and hospital stay in ECHO group. At 30 days, the mortality rate in EGDT group was 35.6% which was significantly higher compared to 14.3% in the ECHO group. At 90 days, the overall mortality was significantly higher in EGDT group compared to ECHO group (40.0% vs 16.7% respectively). Hazardous ratio of mortality was 1.630 [95% confidence interval (CI): 1.123 - 2.366] and 1.653 (95% CI: 1.137 - 2.404) at 30 and 90 days respectively in EGDT group compared to ECHO group. Conclusions: In severe sepsis and septic shock, ECHO-guided management of hemodynamics resulted in a decrease in mortality, lower total fluid intake, higher vasopressor and inotrope support, earlier weaning of vasopressors; and reduced mechanical ventilation days, as well as ICU and hospital stay. Keywords: Echocardiography; EGDT; Severe sepsis; Septic Shock; Adults Citation: Alhabashy WS, Shalaby OM, Elgebaly AS, Abd El Ghafar MS. Echocardiography-guided hemodynamic management of severe sepsis and septic shock in adults: a randomized controlled trial. Anaesth. pain intensive care 2021;25(6):722–732; DOI: 10.35975/apic.v25i6.1694 Received: June 20, 2021, Reviewed: August 10, 2021, Accepted: August 13, 2021
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Alhabashy et al. (2021) conducted an RCT in Severe sepsis and septic shock (n=100). Echocardiography-guided hemodynamic management vs. Early goal-directed therapy (EGDT) was evaluated on Mortality at 30 days (HR 1.630, 95% CI 1.123-2.366, p=0.023). Echocardiography-guided hemodynamic management significantly reduced 30-day mortality to 14.3% compared to 35.6% with early goal-directed therapy in adults with severe sepsis and septic shock.
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