Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review  

作　　者：Hang-Xiang Zhou Chun-Fu Yang He-Yan Wang Yin Teng Hang-Yong He 

机构地区：[1]Department of Critical Care Medicine,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou Province,China [2]Department of Critical Care Medicine,The Sixth Hospital of Guiyang,Guiyang 550002,Guizhou Province,China [3]Department of Respiratory Medicine,The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550002,Guizhou Province,China [4]School of Basic Medicine,Guizhou University of Traditional Chinese Medicine,Guiyang 550002,Guizhou Province,China [5]Department of Thoracic Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou Province,China [6]Department of Respiratory and Critical Care Medicine,Beijing Chao-Yang Hospital,Beijing 100020,China [7]Beijing Institute of Respiratory Medicine,Beijing Chao-Yang Hospital,Beijing 100020,China [8]Beijing Key Laboratory of Respiratory and Pulmonary Circulation,Beijing Chao-Yang Hospital,Beijing 100020,China

出　　处：《World Journal of Critical Care Medicine》2023年第4期204-216,共13页世界重症医学杂志

摘　　要：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 via 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.

关 键 词：Septic shock RESUSCITATION VASOPRESSOR NOREPINEPHRINE VASOPRESSIN Timing 

分 类 号：R459.7[医药卫生—急诊医学]