Ehrman Robert R, Gallien John Z, Smith Reid K, Akers Katherine G, Malik Adrienne N, Harrison Nicholas E, Welch Robert D, Levy Phillip D, Sherwin Robert L
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI.
Department of Emergency Medicine, Detroit Medical Center/Sinai-Grace Hospital, Detroit, MI.
Crit Care Explor. 2019 May 23;1(5):e0015. doi: 10.1097/CCE.0000000000000015. eCollection 2019 May.
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.
We searched PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar from inception until April 2018.
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.
We extracted study details, patient characteristics, volume responsiveness assessment method, and mortality data.
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.
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.
静脉输液复苏是脓毒症治疗中的关键环节。尽管最佳输液量尚不清楚，但有证据表明过量输液可能有害。容量状态的静态指标尚未被证明是有意义的复苏终点。与静态指标相比，容量反应性的测定可能具有益处，但其对结局的影响尚不清楚。本系统评价和荟萃分析的目的是确定采用容量反应性指导的方法进行复苏是否能改善脓毒症患者的结局。
我们检索了PubMed、EMBASE、CINAHL、科学网、Cochrane图书馆和谷歌学术，检索时间从建库至2018年4月。
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，比较容量反应性指导的液体复苏与标准技术，并报告死亡率数据。
我们提取了研究细节、患者特征、容量反应性评估方法和死亡率数据。
在评估的1224篇摘要和31篇全文中，四项研究（共365例患者）符合纳入标准。采用随机效应模型，容量反应性指导策略在最长随访时的合并死亡比值比为0.87（95%CI，0.49 - 1.54）。由于各研究报告的异质性，无法对临床数据进行合并。
我们发现，与标准复苏策略相比，采用容量反应性指导方法进行复苏的脓毒症患者死亡率无显著差异。目前尚不清楚这一结果是由于样本量小还是容量反应性指导方法确实缺乏疗效。
