Adjunctive Vasopressors in Patients with Septic Shock: Protocol for a Systematic Review and Meta-Analysis.
Adjunctive Vasopressors in Patients with Septic Shock: Protocol for a Systematic Review and Meta-Analysis.
复制标题
感染性休克患者的辅助血管升压药：系统评价和荟萃分析方案。
DOI：
10.1101/2023.07.29.23293364
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Morgan,RebeccaL
中科院分区：
文献类型：
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作者：
Bauer,SethR;Wieruszewski,PatrickM;Bissell,BrittanyD;Dugar,Siddharth;Sacha,GretchenL;Sato,Ryota;Siuba,MatthewT;Schleicher,Mary;Vachharajani,Vidula;Falck-Ytter,Yngve;Morgan,RebeccaL
背景超过三分之一的感染性休克患者在一线血管加压药基础上加用抗感染性血管加压药。然而，没有随机试验发现使用血管加压药可以改善死亡率。已发表的系统性综述和荟萃分析试图为预防性血管加压药的使用提供信息，但每一篇已发表的综述都有其局限性，阻碍了对其的解释。这篇综述的目的是克服以前的审查的局限性，通过系统地合成的直接证据，在感染性休克的成人患者中使用抗血管加压药治疗。MethodsWe将进行系统的回顾和荟萃分析的随机对照试验评估抗血管加压药（血管加压素类似物，血管紧张素II，羟钴胺，亚甲蓝，和儿茶酚胺类似物）在感染性休克的成人患者。将通过MEDLINE、Embase、CENTRAL和既往系统性综述的参考文献列表的综合检索来识别相关研究。仅纳入比较感染性休克成人患者（>75%的受试者患有感染性休克）中使用强制性血管加压药（> 75%的受试者在入组时使用血管加压药）与标准治疗血管加压药的随机试验。将筛选标题和摘要，评估全文文章的合格性，并从纳入的研究中提取数据。关注的结局包括短期死亡率、中期死亡率、肾脏替代治疗、指/外周缺血和静脉血栓栓塞。将使用随机效应模型进行成对荟萃分析，以估计结局的风险比。偏倚的风险将被裁定与科克伦风险偏倚2工具，和等级将被用来评估的身体的证据的确定性。DiscussionAlthough抗血管加压药是常用的感染性休克患者的影响，对患者的重要结果是不清楚的。本研究计划采用严格的系统性综述方法，包括严格遵守既定指南，以克服先前发表的综述的局限性，并为感染性休克成人使用抗血管加压药的临床实践和治疗指南提供信息。系统性综述注册PROSPERO CRD 4202327984
BackgroundOver one-third of patients with septic shock have adjunctive vasopressors added to first-line vasopressors. However, no randomized trial has detected improved mortality with adjunctive vasopressors. Published systematic reviews and meta-analysis have sought to inform the use of adjunctive vasopressors, yet each published review has limitations that hinder its interpretation. This review aims to overcome the limitations of previous reviews by systematically synthesizing the direct evidence for adjunctive vasopressor therapy use in adult patients with septic shock.MethodsWe will conduct a systematic review and meta-analysis of randomized controlled trials evaluating adjunctive vasopressors (vasopressin analogues, angiotensin II, hydroxocobalamin, methylene blue, and catecholamine analogues) in adult patients with septic shock. Relevant studies will be identified through comprehensive searches of MEDLINE, Embase, CENTRAL, and reference lists of previous systematic reviews. Only randomized trials comparing adjunctive vasopressors (>75% of subjects on vasopressors at enrollment) to standard care vasopressors in adults with septic shock (>75% of subjects having septic shock) will be included. Titles and abstracts will be screened, full-text articles assessed for eligibility, and data extracted from included studies. Outcomes of interest include short-term mortality, intermediate-term mortality, kidney replacement therapy, digital/peripheral ischemia, and venous thromboembolism. Pairwise meta-analysis using a random-effects model will be utilized to estimate the risk ratio for the outcomes. Risk of bias will be adjudicated with the Cochrane Risk of Bias 2 tool, and GRADE will be used to rate the certainty of the body of evidence.DiscussionAlthough adjunctive vasopressors are commonly used in patients with septic shock their effect on patient-important outcomes is unclear. This study is planned to use rigorous systematic review methodology, including strict adhere to established guidelines, in order to overcome limitations of previously-published reviews and inform clinical practice and treatment guidelines for the use of adjunctive vasopressors in adults with septic shock.Systematic review registrationPROSPERO CRD4202327984