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早期目标导向治疗在感染性休克管理中的疗效:一项系统评价。

Efficacy of Early Goal-Directed Therapy in Septic Shock Management: A Systematic Review.

作者信息

Acharya Prakash, Virani Shikha, Afreen Sumayya, Perthiani Arvin, Sangster Elizabeth, Lanka Nidhi, Malasevskaia Iana

机构信息

Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.

Medicine, Deccan College of Medical Sciences, Hyderabad, IND.

出版信息

Cureus. 2024 Nov 24;16(11):e74358. doi: 10.7759/cureus.74358. eCollection 2024 Nov.

Abstract

Septic shock is a serious and life-threatening illness marked by potentially fatal and metabolic abnormalities, leading to high mortality rates in adult patients. Early goal-directed therapy (EGDT) was introduced as a systematic approach to manage septic shock through early, protocol-based hemodynamic optimization to improve outcomes. This systematic review aims to evaluate the efficacy of EGDT in managing adult patients with septic shock. A comprehensive search was conducted in multiple databases to identify relevant studies. Randomized controlled trials (RCTs), quasi-experimental, and observational studies with control groups were included. The quality of the studies was assessed using appropriate tools, and data was extracted for synthesis. This systemic review of 31 observational and RCT studies highlights the shortcomings of the one-size-fits-all EGDT strategy for septic shock. Although the preliminary research was encouraging, more recent studies have shown how important customized approaches are. Sophisticated monitoring methods such as tissue oxygenation and OER show potential in supporting customized hemodynamic therapy. Rigid protocols might not be the best option, but early intervention is essential. A move toward individualized treatment is necessary to enhance the prognosis of individuals suffering from septic shock. Future research should focus on well-designed RCTs, exploring comparative effectiveness, sustainability, and alternative monitoring techniques to refine the role of EGDT and develop more effective, evidence-based management strategies.

摘要

感染性休克是一种严重的、危及生命的疾病,其特征为潜在的致命性和代谢异常,导致成年患者死亡率很高。早期目标导向治疗(EGDT)作为一种系统方法被引入,通过基于方案的早期血流动力学优化来管理感染性休克,以改善治疗结果。本系统评价旨在评估EGDT在治疗成年感染性休克患者中的疗效。在多个数据库中进行了全面检索,以识别相关研究。纳入了随机对照试验(RCT)、准实验研究和有对照组的观察性研究。使用适当的工具评估研究质量,并提取数据进行综合分析。这项对31项观察性研究和RCT的系统评价突出了针对感染性休克的一刀切的EGDT策略的缺点。尽管初步研究令人鼓舞,但最近的研究表明了定制方法的重要性。诸如组织氧合和氧摄取率等复杂的监测方法在支持定制血流动力学治疗方面显示出潜力。严格的方案可能不是最佳选择,但早期干预至关重要。转向个体化治疗对于改善感染性休克患者的预后是必要的。未来的研究应集中在设计良好的RCT上,探索比较有效性、可持续性和替代监测技术,以完善EGDT的作用并制定更有效、基于证据的管理策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bae4/11668522/8cda26752ac7/cureus-0016-00000074358-i01.jpg

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