Comparison of Intermittent versus Continuous Superior Venal Caval Oxygen Saturation Monitoring in Early Goal Directed Therapy in Septic Shock: A Systematic Review

Early goal directed therapy (EGDT) is a bundle of care (monitoring ScvO(2) and lactate along with clinical parameters and instituting therapy) that has shown to improve outcomes in patients with septic shock. We conducted a systematic review of clinical trials and observational studies to compare intermittent versus continuous monitoring of ScvO(2). We did major database searches till August 2020. Hospitalized children (>2months age) and adults with septic shock were included. The intervention was intermittent ScvO(2) monitoring, and the comparator was continuous ScvO(2) monitoring. The primary outcome is allcause mortality. Of 564 citations, 3 studies (n = 541) including both children and adults were included in the analysis. There was no significant difference in the overall/all-cause mortality (two randomized controlled trials; 258 participants) between the intermittent and continuous ScvO(2) monitoring groups (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.8-1.24). However, a single observational study (283 participants) showed a significant increase in mortality in the intermittent group (RR: 1.46; 95% CI: 1.03-2.05). The GRADE evidence generated for overall/all-cause mortality was of moderate certainty. To conclude, the present meta-analysis did not find any significant difference between intermittent and continuous ScvO(2) monitoring in patients with septic shock.

Automated summary

A systematic review compared intermittent and continuous ScvO(2) monitoring in patients with septic shock, finding no significant difference in overall mortality between the two methods. However, one observational study showed an increase in mortality in the intermittent monitoring group, indicating the need for further research in this area.