Wang Jocelyn, Blake Leann Marie, Orozco Nicolas, Fiorini Kyle, McChesney Chris, Slessarev Marat, Prager Ross, Leligdowicz Aleksandra, Sharif Sameer, Lewis Kimberley, Rochwerg Bram, Honarmand Kimia, Ball Ian M, Arntfield Robert, Wong Michelle, Bokhary Diyaa, Bafaraj Ahmad, Van Nynatten Logan, Fero Henri, Russell Evan, Basmaji John
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
Crit Care Explor. 2025 Sep 15;7(9):e1303. doi: 10.1097/CCE.0000000000001303. eCollection 2025 Sep 1.
To determine the impact of using dynamic measures of fluid responsiveness in guiding the resuscitation of adult patients with sepsis and septic shock.
We searched MEDLINE, Embase, and unpublished sources from inception to February 3, 2025.
We included randomized controlled trials (RCTs) that evaluated the use of dynamic measures of fluid responsiveness to guide resuscitation compared with any other method in patients with sepsis and septic shock.
We collected data regarding study and patient characteristics, definitions of fluid responsiveness, modality for assessing fluid responsiveness, and outcome data. We performed a random-effects meta-analysis and rated the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We included nine eligible RCTs (n = 698 patients). The use of dynamic measures of fluid responsiveness to guide IV fluid (IVF) administration of patients with septic shock probably reduces 28-day mortality (relative risk] 0.61; 95% CI, 0.42-0.90, moderate certainty), may reduce the risk of acute kidney injury (AKI) (RR 0.66; 95% CI, 0.44-0.98, low certainty), and cumulative fluid balance on day 3 (mean difference -1.57L; 95% CI, -2.44 L to -0.69 L, low certainty). The use of dynamic measures of fluid responsiveness has an uncertain effect on ICU mortality, ICU and hospital length of stay, need for and duration of mechanical ventilation, need for renal replacement therapy, vasoactive medication administration, duration of vasopressor use, and IVF administration on day 1.
In adult patients with sepsis and septic shock, using dynamic measures of fluid responsiveness may improve survival and reduce the risk of AKI. Future studies should evaluate the impact of this intervention on other important clinical outcomes and determine the comparative efficacy of specific modalities for assessing fluid responsiveness.
确定使用液体反应性动态指标指导脓毒症和脓毒性休克成年患者复苏的影响。
我们检索了MEDLINE、Embase以及自数据库创建至2025年2月3日的未发表文献。
我们纳入了随机对照试验（RCT），这些试验评估了在脓毒症和脓毒性休克患者中，与任何其他方法相比，使用液体反应性动态指标指导复苏的情况。
我们收集了有关研究和患者特征、液体反应性定义、评估液体反应性的方式以及结局数据。我们进行了随机效应荟萃分析，并使用推荐分级评估、制定和评价框架对证据的确定性进行了评级。
我们纳入了9项符合条件的RCT（n = 698例患者）。使用液体反应性动态指标指导脓毒性休克患者静脉输液（IVF）给药可能会降低28天死亡率（相对风险0.61；95%CI，0.42 - 0.90，中等确定性），可能会降低急性肾损伤（AKI）风险（RR 0.66；95%CI，0.44 - 0.98，低确定性），以及第3天的累积液体平衡（平均差 -1.57L；95%CI，-2.44L至 -0.69L，低确定性）。使用液体反应性动态指标对ICU死亡率、ICU和住院时间、机械通气需求及持续时间、肾脏替代治疗需求、血管活性药物给药、血管升压药使用持续时间以及第1天的IVF给药的影响尚不确定。
在脓毒症和脓毒性休克成年患者中，使用液体反应性动态指标可能会提高生存率并降低AKI风险。未来研究应评估该干预措施对其他重要临床结局的影响，并确定评估液体反应性的特定方式的比较疗效。
