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
{"title":"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。","authors":"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","doi":"10.1097/CCM.0000000000006399","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock.</p><p><strong>Data source: </strong>We searched MEDLINE, Embase, and unpublished sources from inception to December 2023.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock.</p><p><strong>Data extraction: </strong>We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes.</p><p><strong>Data synthesis: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"1661-1673"},"PeriodicalIF":7.7000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.\",\"authors\":\"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\",\"doi\":\"10.1097/CCM.0000000000006399\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock.</p><p><strong>Data source: </strong>We searched MEDLINE, Embase, and unpublished sources from inception to December 2023.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock.</p><p><strong>Data extraction: </strong>We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes.</p><p><strong>Data synthesis: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"1661-1673\"},\"PeriodicalIF\":7.7000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006399\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006399","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
The Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.
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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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.
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