肺超声引导下液体复苏治疗新生儿感染性休克：一项随机对照试验。
Lung ultrasound-guided fluid resuscitation in neonatal septic shock: A randomized controlled trial.
作者信息
Huang Dabin, You Chuming, Mai Xiaowei, Li Lin, Meng Qiong, Liang Zhenyu
机构信息
Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China.
Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
Eur J Pediatr. 2024 Mar;183(3):1255-1263. doi: 10.1007/s00431-023-05371-9. Epub 2023 Dec 14.
UNLABELLED
This randomized controlled trial aimed to determine whether lung ultrasound-guided fluid resuscitation improves the clinical outcomes of neonates with septic shock. Seventy-two patients were randomly assigned to undergo treatment with lung ultrasound-guided fluid resuscitation (LUGFR), or with usual fluid resuscitation (Control) in the first 6 h since the start of the sepsis treatment. The primary study outcome was 14-day mortality after randomization. Fourteen-day mortalities in the two groups were not significantly different (LUGFR group, 13.89%; control group, 16.67%; p = 0.76; hazard ratio 0.81 [95% CI 0.27-2.50]). The LUGFR group experienced shorter length of neonatal intensive care unit (NICU) stays (21 vs. 26 days, p = 0.04) and hospital stays (32 vs. 39 days, p = 0.01), and less fluid was used in the first 6 h (77 vs. 106 mL/kg, p = 0.02). Further, our study found that ultrasound-guided fluid resuscitation can significantly reduce the incidence of acute kidney injury (25% vs. 47.2%, p = 0.05) and intracranial hemorrhage (grades I-II) within 72 h (13.9% vs. 36.1%, p = 0.03). However, no significant difference was found in the resolution of shock within 1 h or 6 h, use of mechanical ventilation or vasopressor support, time to achieve lactate level < 2 mmol/L, and the number of participants developing hepatomegaly in the first 6 h.
CONCLUSION
Lung ultrasound is a noninvasive and convenient tool for predicting fluid overload in neonatal septic shock. Fluid resuscitation guided by lung ultrasound can shorten the length of hospital and NICU stays, reduce the amount of fluid used in the first 6 h, and reduce the risk of acute kidney injury and intracranial hemorrhage.
TRIAL REGISTRATION
Registered in Guangdong Second Provincial General Hospital: 2021-IIT-156-EK, date of registration: November 13, 2021. And ClinicalTrials.gov: NCT06144463 (retrospectively registered).
WHAT IS KNOWN
• Excessive fluid resuscitation in neonates with septic shock had worse outcomes.
WHAT IS NEW
• Lung ultrasound should be routinely used to guide fluid resuscitation in neonatal septic shock.
未标注
本随机对照试验旨在确定肺部超声引导下的液体复苏是否能改善新生儿感染性休克的临床结局。72例患者被随机分配，在脓毒症治疗开始后的前6小时内接受肺部超声引导下的液体复苏（LUGFR）治疗或常规液体复苏（对照组）。主要研究结局是随机分组后的14天死亡率。两组的14天死亡率无显著差异（LUGFR组为13.89%；对照组为16.67%；p = 0.76；风险比0.81[95%CI 0.27 - 2.50]）。LUGFR组新生儿重症监护病房（NICU）住院时间较短（21天对26天，p = 0.04），住院时间也较短（32天对39天，p = 0.01），且前6小时使用的液体量较少（77对106 mL/kg，p = 0.02）。此外，我们的研究发现，超声引导下的液体复苏可显著降低急性肾损伤的发生率（25%对47.2%，p = 0.05）以及72小时内颅内出血（I - II级）的发生率（13.9%对36.1%，p = 0.03）。然而，在1小时或6小时内休克的缓解情况、机械通气或血管活性药物支持的使用、乳酸水平降至<2 mmol/L的时间以及前6小时内发生肝肿大的参与者数量方面，未发现显著差异。
结论
肺部超声是预测新生儿感染性休克液体超负荷的一种无创且便捷的工具。肺部超声引导下的液体复苏可缩短住院和NICU住院时间，减少前6小时的液体使用量，并降低急性肾损伤和颅内出血的风险。
试验注册
在广东省第二人民医院注册：2021 - IIT - 156 - EK，注册日期：2021年11月13日。以及ClinicalTrials.gov：NCT06144463（回顾性注册）。
已知信息
• 新生儿感染性休克中过度的液体复苏会导致更差的结局。
新发现
• 肺部超声应常规用于指导新生儿感染性休克的液体复苏。
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