The Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-18 DOI:10.1097/CCM.0000000000006399

John Basmaji, Robert Arntfield, Karishma Desai, Vincent I Lau, Kim Lewis, Bram Rochwerg, Kyle Fiorini, Kimia Honarmand, Marat Slessarev, Aleks Leligdowicz, Brian Park, Ross Prager, Michelle Y S Wong, Philip M Jones, Ian M Ball, Nicolas Orozco, Maureen Meade, Lehana Thabane, Gordon Guyatt

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Abstract

Objective: To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock.

Data source: We searched MEDLINE, Embase, and unpublished sources from inception to December 2023.

Study selection: We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock.

Data extraction: We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes.

Data synthesis: We identified 18 eligible RCTs. POCUS slightly influences physicians' plans for IV fluid (IVF) and vasoactive medication prescription (moderate certainty), but results in little to no changes in the administration of IVF (low to high certainty) or inotropes (high certainty). POCUS may result in no change in the number of CT scans performed (low certainty) but probably reduces the number of diagnostic echocardiograms performed (moderate certainty). POCUS-guided resuscitation probably reduces 28-day mortality (relative risk [RR] 0.88; 95% CI, 0.78-0.99), the duration of vasoactive medication (mean difference -0.73 d; 95% CI, -1.16 to -0.30), and the need for renal replacement therapy (RRT) (RR 0.80; 95% CI, 0.63-1.02) (low to moderate certainty evidence), and lactate clearance (high certainty evidence). POCUS-guided resuscitation may results in little to no difference in ICU or hospital admissions, ICU and hospital length of stay, and the need for mechanical ventilation (MV) (low to moderate certainty evidence). There is an uncertain effect on the risk of acute kidney injury and the duration of MV or RRT (very low certainty evidence).

Conclusions: POCUS-guided resuscitation in shock may yield important patient and health system benefits. Due to lack of sufficient evidence, we were unable to explore how the thresholds of operator competency, frequency, and timing of POCUS scans impact patient outcomes.

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护理点超声引导复苏对休克患者临床疗效的影响：系统回顾和 Meta 分析。

目的确定护理点超声（POCUS）引导下的复苏对休克成人患者临床预后的影响：我们检索了从开始到 2023 年 12 月的 MEDLINE、Embase 和未发表的资料来源：我们纳入了研究使用 POCUS 指导休克患者复苏的随机对照试验（RCT）：我们收集了有关研究和患者特征、POCUS 方案、对照组干预措施和结果的数据：我们确定了 18 项符合条件的 RCT。POCUS对医生的静脉输液（IVF）和血管活性药物处方计划略有影响（中等确定性），但对静脉输液（低至高确定性）或肌注（高确定性）的使用几乎没有影响。POCUS 可能不会改变 CT 扫描的次数（低度确定性），但可能会减少超声心动图诊断的次数（中度确定性）。POCUS 指导下的复苏可能会降低 28 天死亡率（相对风险 [RR] 0.88；95% CI，0.78-0.99）、血管活性药物持续时间（平均差异-0.73 天；95% CI，-1.16--0.30）、肾脏替代疗法需求（RRT）（RR 0.80；95% CI，0.63-1.02）（中低度确定性证据）和乳酸清除率（高度确定性证据）。POCUS 指导下的复苏可能会导致 ICU 或医院入院率、ICU 和医院住院时间以及机械通气（MV）需求几乎没有差异（中低度确定性证据）。对急性肾损伤风险和机械通气或 RRT 持续时间的影响尚不确定（极低确定性证据）：休克患者在 POCUS 指导下进行复苏可为患者和医疗系统带来重要益处。由于缺乏足够的证据，我们无法探讨操作者能力阈值、POCUS 扫描频率和时间对患者预后的影响。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.