首页|Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock:a systematic review and meta-analysis
Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock:a systematic review and meta-analysis
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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[Cl]:0.65 to 0.94;P=0.007)and 24-hourfluid volume(mean differences[MD]:-1.02;95％Cl:-1.28 to-0.75;P＜0.001),low heterogeneity(/2=29％,I2=0％),and increased dose of norepinephrine(MD:0.07;95％Cl:0.02-0.11;P=0.002)and dobutamine dose(MD:2.2;95％Cl:0.35-4.04;P=0.02),with low heterogeneity(I2=45％,I2=0％).There was no reduction in the risk of dobutamine use(risk ratio:1.67;95％Cl:0.52 to 5.36;P=0.39;I2=0％).Inferior vena cava-related measures reduced the length of hospital stay(MD:-2.91;95％Cl:-5.2 to-0.62;P=0.01;low hetero-geneity,I2=8％)and length of intensive care unit stay(MD:-2.77;95％Cl:-4.51 to-1.02;P=0.002;low heterogeneity,I2=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％Cl:-3.81 to 6.81;P=0.58;I2=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.
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