Resuscitation Guided by Volume Responsiveness Does Not Reduce Mortality in Sepsis: A Meta-Analysis.
Resuscitation Guided by Volume Responsiveness Does Not Reduce Mortality in Sepsis: A Meta-Analysis.
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DOI：
10.1097/cce.0000000000000015
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发表时间：
2019-05-01
影响因子：
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通讯作者：
Sherwin, Robert L
中科院分区：
文献类型：
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作者：
Ehrman, Robert R;Gallien, John Z;Sherwin, Robert L
静脉输液复苏是败血症治疗的关键组成部分。尽管静脉输液的最佳量尚不清楚，但有证据表明过量给药可能有害。容量状态的静态测量尚未被证明是有意义的复苏终点。容量反应性的确定比静态测量具有假定的好处，但其对结果的影响尚不清楚。本系统评价和荟萃分析的目的是确定采用容量反应引导方法进行复苏是否可以改善脓毒症患者的预后。 数据来源：我们检索了从成立到 2018 年 4 月的 PubMed、EMBASE、CINAHL、Web of Science、Cochrane 图书馆和 Google Scholar。 研究选择：对脓毒症、严重脓毒症或脓毒性休克患者进行的前瞻性研究，比较容量反应引导方法数据提取：我们提取了研究详细信息、患者特征、容量反应评估方法和死亡率数据。数据合成：在评估的 1,224 篇摘要和 31 篇全文中，有 4 项研究（总共 365 名患者）符合纳入标准。使用随机效应模型，采用容量反应指导策略进行最长随访时死亡率的汇总比值比为 0.87（95% CI，0.49-1.54）。由于个别研究报告的异质性，不可能合并临床数据。结论：我们发现，与标准复苏策略相比，采用容量反应引导方法复苏的脓毒症患者的死亡率没有显着差异。目前尚不清楚这些发现是由于样本量小还是容量反应引导方法确实缺乏功效。
Resuscitation with IV fluids is a critical component in the management of sepsis. Although the optimal volume of IV fluid is unknown, there is evidence that excessive administration can be deleterious. Static measures of volume status have not proven to be meaningful resuscitative endpoints. Determination of volume responsiveness has putative benefits over static measures, but its effect on outcomes is unknown. The goal of this systematic review and meta-analysis was to determine if resuscitation with a volume responsiveness-guided approach leads to improved outcomes in septic patients.DATA SOURCES: We searched PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar from inception until April 2018.STUDY SELECTION: Prospective studies of patients with sepsis, severe sepsis, or septic shock that compared volume responsiveness-guided fluid resuscitation to standard techniques and reported mortality data.DATA EXTRACTION: We extracted study details, patient characteristics, volume responsiveness assessment method, and mortality data.DATA SYNTHESIS: Of the 1,224 abstracts and 31 full-texts evaluated, four studies (total 365 patients) met inclusion criteria. Using random effects modeling, the pooled odds ratio for mortality at time of longest follow-up with a volume responsiveness-guided strategy was 0.87 (95% CI, 0.49-1.54). Pooling of clinical data was not possibly owing to heterogeneity of reporting in individual studies.CONCLUSIONS: We found no significant difference in mortality between septic patients resuscitated with a volume responsiveness-guided approach compared with standard resuscitative strategies. It remains unclear whether the findings are due to the small sample size or a true lack of efficacy of a volume responsiveness-guided approach.