Zhou Hang-Xiang, Yang Chun-Fu, Wang He-Yan, Teng Yin, He Hang-Yong
Department of Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China.
Department of Critical Care Medicine, The Sixth Hospital of Guiyang, Guiyang 550002, Guizhou Province, China.
World J Crit Care Med. 2023 Sep 9;12(4):204-216. doi: 10.5492/wjccm.v12.i4.204.
Septic shock treatment remains a major challenge for intensive care units, despite the recent prominent advances in both management and outcomes. Vasopressors serve as a cornerstone of septic shock therapy, but there is still controversy over the timing of administration. Specifically, it remains unclear whether vasopressors should be used early in the course of treatment. Here, we provide a systematic review of the literature on the timing of vasopressor administration. Research was systematically identified through PubMed, Embase and Cochrane searching according to PRISMA guidelines. Fourteen studies met the eligibility criteria and were included in the review. The pathophysiological basis for early vasopressor use was classified, with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII. We found that mortality was 28.1%-47.7% in the early vasopressors group, and 33.6%-54.5% in the control group. We also investigated the issue of vasopressor responsiveness. Furthermore, we acknowledged the subsequent challenge of administration of high-dose norepinephrine peripheral veins with early vasopressor use. Based on the literature review, we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.
尽管在管理和治疗效果方面最近取得了显著进展，但感染性休克的治疗仍然是重症监护病房面临的一项重大挑战。血管升压药是感染性休克治疗的基石，但在给药时机上仍存在争议。具体而言，血管升压药是否应在治疗早期使用仍不明确。在此，我们对有关血管升压药给药时机的文献进行了系统综述。根据PRISMA指南，通过PubMed、Embase和Cochrane检索系统地识别研究。14项研究符合纳入标准并被纳入综述。对早期使用血管升压药的病理生理基础进行了分类，并探讨了早期使用单一血管升压药或其与血管加压素或血管紧张素II联合使用的指征。我们发现，早期使用血管升压药组的死亡率为28.1%-47.7%，对照组为33.6%-54.5%。我们还研究了血管升压药反应性的问题。此外，我们认识到早期使用血管升压药时通过外周静脉给予高剂量去甲肾上腺素的后续挑战。基于文献综述，我们提出了在感染性休克复苏中早期启动血管升压药的可能方案。
