Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock:a systematic review and meta-analysis  

作　　者：Zheyuan Chen Xiao Han Ying Liu Mengjun Wang Beibei Wang Ling Wang Hongxu Jin 

机构地区：[1]Emergency Department,General Hospital of Northern Theater Command,Shenyang,Liaoning,China [2]General Hospital of Northern Theater Command,China Medical University,Shenyang,Liaoning,China [3]Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing,China

出　　处：《Emergency and Critical Care Medicine》2024年第2期82-89,共8页急危重症医学（英文）

摘　　要：Background:Ultrasound is widely used in critical care for fluid resuscitation in critically ill patients.We conducted a systematic review to assess the relationship between ultrasound-guided fluid resuscitation strategies and usual care in septic shock.Methods:We searched PubMed,Embase,Cochrane Library,Web of Science,and registers for randomized controlled trials to evaluate the prognosis of ultrasound-guided fluid resuscitation in patients with septic shock.Results:Twelve randomized controlled studies with 947 participants were included.Ultrasound-guided fluid resuscitation in patients with septic shock was associated with reduced mortality(risk ratio:0.78;95%confidence interval[CI]:0.65 to 0.94;P=0.007)and 24-hour fluid volume(mean differences[MD]:−1.02;95%CI:−1.28 to−0.75;P<0.001),low heterogeneity(I^(2)=29%,I^(2)=0%),and increased dose of norepinephrine(MD:0.07;95%CI:0.02-0.11;P=0.002)and dobutamine dose(MD:2.2;95%CI:0.35-4.04;P=0.02),with low heterogeneity(I^(2)=45%,I^(2)=0%).There was no reduction in the risk of dobutamine use(risk ratio:1.67;95%CI:0.52 to 5.36;P=0.39;I^(2)=0%).Inferior vena cava-related measures reduced the length of hospital stay(MD:−2.91;95%CI:−5.2 to−0.62;P=0.01;low heterogeneity,I^(2)=8%)and length of intensive care unit stay(MD:−2.77;95%CI:−4.51 to−1.02;P=0.002;low heterogeneity,I^(2)=0%).The use of the passive leg-raising test combined with echocardiography to assess fluid reactivity was superior.Ultrasound-guided fluid resuscitation did not significantly change the length of the free intensive care unit stay(MD:1.5;95%CI:−3.81 to 6.81;P=0.58;I^(2)=0%).Conclusion:Ultrasound-guided fluid resuscitation in patients with septic shock is beneficial,especially when using inferior vena cava-related measures and the passive leg-raising test combined with echocardiography.

关 键 词：META-ANALYSIS MORTALITY RESUSCITATION Septic shock Systematic review ULTRASONOGRAPHY 

分 类 号：R459.7[医药卫生—急诊医学]