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急诊科对严重脓毒症和脓毒性休克进行程序化目标导向血流动力学优化管理的荟萃分析。

Meta-analysis of protocolized goal-directed hemodynamic optimization for the management of severe sepsis and septic shock in the Emergency Department.

作者信息

Wira Charles R, Dodge Kelly, Sather John, Dziura James

机构信息

Yale University, Department of Emergency Medicine, New Haven, Connecticut.

Yale University, Department of Emergency Medicine and Surgical Critical Care, New Haven, Connecticut.

出版信息

West J Emerg Med. 2014 Feb;15(1):51-9. doi: 10.5811/westjem.2013.7.6828.

DOI:10.5811/westjem.2013.7.6828
PMID:24696750
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3952890/
Abstract

INTRODUCTION

To perform a meta-analysis identifying studies instituting protocolized hemodynamic optimization in the emergency department (ED) for patients with severe sepsis and septic shock.

METHODS

We modeled the structure of this analysis after the QUORUM and MOOSE published recommendations for scientific reviews. A computer search to identify articles was performed from 1980 to present. Studies included for analysis were adult controlled trials implementing protocolized hemodynamic optimization in the ED for patients with severe sepsis and septic shock. Primary outcome data was extracted and analyzed by 2 reviewers with the primary endpoint being short-term mortality reported either as 28-day or in-hospital mortality.

RESULTS

We identified 1,323 articles with 65 retrieved for review. After application of inclusion and exclusion criteria 25 studies (15 manuscripts, 10 abstracts) were included for analysis (n=9597). The mortality rate for patients receiving protocolized hemodynamic optimization (n=6031) was 25.8% contrasted to 41.6% in control groups (n=3566, p<0.0001).

CONCLUSION

Protocolized hemodynamic optimization in the ED for patients with severe sepsis and septic shock appears to reduce mortality.

摘要

引言

进行一项荟萃分析，以确定在急诊科（ED）对严重脓毒症和脓毒性休克患者进行血流动力学优化方案的研究。

方法

我们根据QUORUM和MOOSE发表的科学综述建议对本分析的结构进行建模。从1980年至今进行计算机检索以识别文章。纳入分析的研究为针对严重脓毒症和脓毒性休克患者在急诊科实施血流动力学优化方案的成人对照试验。由2名审阅者提取并分析主要结局数据，主要终点为报告的28天或住院死亡率的短期死亡率。

结果

我们识别出1323篇文章，检索到65篇以供审阅。应用纳入和排除标准后，纳入25项研究（15篇手稿，10篇摘要）进行分析（n = 9597）。接受血流动力学优化方案的患者（n = 6031）的死亡率为25.8%，而对照组（n = 3566，p < 0.0001）为41.6%。

结论

在急诊科对严重脓毒症和脓毒性休克患者进行血流动力学优化方案似乎可降低死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/5c1fcb24fb28/i1936-900X-15-1-51-f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/486eff7f8a05/i1936-900X-15-1-51-f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/3609c2bb28f2/i1936-900X-15-1-51-f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/5c1fcb24fb28/i1936-900X-15-1-51-f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/486eff7f8a05/i1936-900X-15-1-51-f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/3609c2bb28f2/i1936-900X-15-1-51-f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f441/3952890/5c1fcb24fb28/i1936-900X-15-1-51-f03.jpg

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