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 (>2 months 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 "all-cause 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.