Naumann David N, Dretzke Janine, Hutchings Sam, Midwinter Mark J
National Institute of Health Research, Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
School of Health & Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
Syst Rev. 2015 Oct 5;4:135. doi: 10.1186/s13643-015-0113-4.
Modern resuscitation strategies following haemorrhagic shock are influenced by global haemodynamic parameters such as blood pressure and cardiac output. Microcirculatory dysfunction in this context may persist even after restoration of satisfactory global parameters. Additional monitoring of the microcirculatory function may therefore be warranted in order to facilitate goal-directed therapy at a tissue oxygenation level. Although such a phenomenon is recognised in the case of sepsis, clinical evidence regarding the behaviour of the microcirculation following the delivery of resuscitation fluids after haemorrhagic shock is sparse. A summation of the current state of pre-clinical evidence is justified in order to direct avenues for future clinical research.
METHODS/DESIGN: Systematic review methodology will be utilised in order to identify relevant studies, assess for bias, and extract data for analysis. Medical databases will be searched to find pre-clinical studies that monitor the microcirculatory function following haemorrhagic shock and subsequent fluid resuscitation. Different fluid types (e.g. blood products, crystalloid, and colloid fluids) will be compared. The search strategy will combine terms for the animal model, resuscitation fluid, and microcirculatory parameters. Randomised and non-randomised experiments, as well as case series, will be eligible for inclusion. Specific quality assessment tools for pre-clinical research will be used depending on study design. A combination of narrative and meta-analysis techniques will be used for the synthesis of data.
The choice of type, sequence, and quantity of resuscitation fluid following haemorrhagic shock is controversial, and the optimal strategy for restoration of microcirculatory function is yet unknown. A detailed examination of pre-clinical data regarding the microcirculation is timely and will enable a focussed approach to clinical research for the improvement of resuscitation following haemorrhagic shock.
Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies ( CAMARADES).
失血性休克后的现代复苏策略受诸如血压和心输出量等整体血流动力学参数的影响。在此情况下，即使整体参数恢复到令人满意的水平，微循环功能障碍仍可能持续存在。因此，可能有必要额外监测微循环功能，以便在组织氧合水平上促进目标导向治疗。尽管脓毒症时会出现这种现象，但关于失血性休克后给予复苏液后微循环行为的临床证据却很少。总结临床前证据的现状对于指导未来临床研究的方向是合理的。
方法/设计：将采用系统评价方法来识别相关研究、评估偏倚并提取数据进行分析。将检索医学数据库以查找监测失血性休克及随后液体复苏后微循环功能的临床前研究。将比较不同类型的液体（如血液制品、晶体液和胶体液）。检索策略将结合动物模型、复苏液和微循环参数的术语。随机和非随机实验以及病例系列均符合纳入标准。将根据研究设计使用特定的临床前研究质量评估工具。将使用叙述性和荟萃分析技术相结合的方法来综合数据。
失血性休克后复苏液的类型、顺序和数量的选择存在争议，恢复微循环功能的最佳策略尚不清楚。及时详细检查有关微循环的临床前数据将有助于针对失血性休克后改善复苏的临床研究采取有针对性的方法。
实验研究动物数据的荟萃分析和综述协作方法（CAMARADES）。
