Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature.
Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature.
复制标题
败血症患者的随机临床试验中的血液动力学目标：文献进行系统评价。
DOI：
10.1186/cc5948
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Pronovost P
中科院分区：
文献类型：
--
作者：
Sevransky JE;Nour S;Susla GM;Needham DM;Hollenberg S;Pronovost P
脓毒症患者的发病率和死亡率很高。我们试图对文献进行系统回顾，以评估治疗的血流动力学目标与患者结果之间的关联。我们对文献进行了全面检索，系统地回顾了脓毒症患者临床试验中使用的血流动力学目标。我们使用 Pubmed (1965-2006 年 6 月)、Embase (1974-2006 年 6 月)、CINAHL (1982-2006 年 6 月)、pre-CINAHL 和 Cochrane 图书馆 (2006 年第 3 期) 电子数据库检索了 2006 年 8 月 1 日以下术语的文献：败血症、败血性休克、严重败血症、人体临床试验。我们还手工检索了参考资料和我们的个人文件。如果研究符合以下所有标准，则选择研究：随机对照试验研究设计；成年脓毒症患者的入组；存在患者管理的血流动力学目标； > 24小时跟踪；并将生存作为结果。研究由两名研究人员独立选择和审查。共检索到引用 6,006 条，审评符合条件的文章 13 篇。平均动脉压是九项研究的治疗目标，收缩压是三项研究的治疗目标。四项、三项和五项研究分别给出了肺动脉闭塞压、中心静脉压和心脏指数的目标。试验中使用的血流动力学目标范围为：平均动脉压60-100 mmHg，中心静脉压6-13 mmHg，肺动脉闭塞压13-17 mmHg，心脏指数3-6 l/min/m2。所有使用收缩压目标的试验均以 90 mmHg 为目标。对于那些指定血流动力学目标的试验，广泛的治疗目标表明脓毒症患者管理的血压和充盈压目标缺乏共识。不同试验的针对性措施也不一致。需要进一步的研究来确定血流动力学目标缺乏一致性是否会导致新型脓毒症疗法临床试验的治疗效果的异质性。
Patients with sepsis suffer high morbidity and mortality. We sought to conduct a systematic review of the literature to evaluate the association between hemodynamic goals of therapy and patient outcomes. We conducted a comprehensive search of the literature to systematically review hemodynamic goals used in clinical trials in patients with sepsis. We searched the literature using the Pubmed (1965–June 2006), Embase (1974–June 2006), CINAHL (1982–June 2006), pre-CINAHL, and Cochrane Library (2006, issue 3) electronic databases on 1 August 2006 for the following terms: sepsis, septic shock, severe sepsis, human clinical trials. We also hand-searched references and our personal files. Studies were selected if they met all of the following criteria: randomized, controlled trial study design; enrollment of adult patients with sepsis; presence of a hemodynamic goal for patient management; > 24-hour follow-up; and survival included as an outcome. Studies were independently selected and reviewed by two investigators. A total of 6,006 citations were retrieved, and 13 eligible articles were reviewed. Mean arterial pressure was a treatment goal in nine studies, and systolic blood pressure was a treatment goal in three studies. A goal for pulmonary artery occlusion pressure, central venous pressure, and cardiac index was given in four, three, and five studies, respectively. The range of hemodynamic goals used in the trials were: mean arterial pressure 60–100 mmHg, central venous pressure 6–13 mmHg, pulmonary artery occlusion pressure 13–17 mmHg, and cardiac index 3–6 l/min/m2. All trials that used a systolic blood pressure goal used 90 mmHg as the aim. For those trials that specify hemodynamic goals, the wide range of treatment targets suggest a lack of agreement on blood pressure and filling pressure goals for management of patients with sepsis. There was also inconsistency between trials in which measures were targeted. Further research is necessary to determine whether this lack of consistency in hemodynamic goals may contribute to heterogeneity in treatment effects for clinical trials of novel sepsis therapies.
登录
查看更多内容
影响因子：
158.5
作者：
Abraham, E;Laterre, P;Macias, WL
通讯作者：
Macias, WL
影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
影响因子：
8.8
作者：
Cole, L;Bellomo, R;Ronco, C
通讯作者：
Ronco, C
DOI：
10.1164/rccm.2201087
发表时间：
2003-07-15
影响因子：
24.7
作者：
Annane, D;Aegerter, P;Guidet, B
通讯作者：
Guidet, B
影响因子：
8.8
作者：
Osman, David;Ridel, Christophe;Teboul, Jean-Louis
通讯作者：
Teboul, Jean-Louis