Zhang Yijun, Wang Minjie, Lu Zongqing, Yang Min
The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 Anhui China.
Intensive Care Res. 2023;3(1):61-68. doi: 10.1007/s44231-022-00019-y. Epub 2022 Oct 27.
As the Surviving Sepsis Campaign (2021) recommended, patients with sepsis should be given a liquid infusion of 30 ml/kg (ideal body weight). However, the strategy may result in insufficient resuscitation for obese patients with sepsis. Therefore, we conducted a systematic evaluation of the effectiveness of the initial resuscitation strategy in obese sepsis patients.
A computer search of PubMed, Embase, Cochrane library, and other databases collected cohort studies from the beginning of the survey to December 2021 to include articles evaluating initial resuscitation strategies for sepsis-obese patients.
Of the six studies included, five used ideal body weight infusion strategies, and three used actual body weight infusion strategies. Differences in fluid volume were observed between the two strategies, but no significant difference was observed in the mortality of obese sepsis patients. In addition, there may be an infusion strategy other than the above two infusion methods, and the safety and efficacy of the new infusion strategy are unclear. The obesity paradox has been observed in most infusion strategies.
The association between obesity and infusion strategy has rarely been investigated in patients with sepsis and septic shock, and the existing results are conflicting. The risk of bias in all included studies was moderate or high. Before providing broad recommendations on the optimal first resuscitation approach to lower the chance of mortality, further clinical trials, and prospective research need to be done.
正如拯救脓毒症运动（2021年）所建议的，脓毒症患者应接受30毫升/千克（理想体重）的液体输注。然而，该策略可能导致肥胖脓毒症患者复苏不足。因此，我们对肥胖脓毒症患者初始复苏策略的有效性进行了系统评价。
通过计算机检索PubMed、Embase、Cochrane图书馆和其他数据库，收集从调查开始至2021年12月的队列研究，以纳入评估肥胖脓毒症患者初始复苏策略的文章。
纳入的6项研究中，5项采用理想体重输注策略，3项采用实际体重输注策略。两种策略在液体量上存在差异，但肥胖脓毒症患者的死亡率无显著差异。此外，可能存在上述两种输注方法以外的输注策略，新输注策略的安全性和有效性尚不清楚。在大多数输注策略中都观察到了肥胖悖论。
肥胖与输注策略之间的关联在脓毒症和脓毒性休克患者中很少被研究，现有结果相互矛盾。所有纳入研究的偏倚风险为中度或高度。在就降低死亡率的最佳初始复苏方法提供广泛建议之前，需要进行进一步的临床试验和前瞻性研究。
