在败血症休克中使用白蛋白 - - 对多中心RCT数据的后期分析的协议
Tine Sylvest Meyhoff1,2, Anders Granholm1,2, Peter Buhl Hjortrup2,3
1Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Acta anaesthesiologica Scandinavica
|May 29, 2023
概括
强烈推静脉注射白素在大量结晶体体体积后对败血性休克患者进行. 本研究探讨了在重症监护病房影响白蛋白使用的因素,旨在了解实践变化.
科学领域:
- 关键护理医学 关键护理医学
- 临床药理学 临床药理学
- 基于证据的医学基于证据的医学.
背景情况:
- 静脉注射 (IV) 专素是有条件地推给已经接受了大量IV结晶体液的败血症患者.
- 适度的证据确定性支持这一建议.
- 根据患者的因素和位置,在感染性休克的IV专剂中存在潜在的临床变异.
研究的目的:
- 为了对CLASSIC RCT进行临时后二级分析.
- 为了研究患者特征或试验地点与成年ICU患有败血性休克的ICU患者的IV专施用之间的关联.
- 为了探索在使用白蛋白的潜在实践变化.
主要方法:
- 使用保守与自由主义方法对密集护理中的败血性休克流体治疗 (CLASSIC) RCT (n=1554) 的数据.
- 采用与竞争事件的考克斯模型来评估基线特征和试验地点与IV白素给药的关联.
- 调整用于CLASSIC治疗分配的模型 (限制性与标准IV液体) 并考虑竞争事件 (死亡,ICU退院,损失至后续).
主要成果:
- 结果将以95%置信区间和p值的危险比率呈现.
- 将报告基线特征或部位和IV白剂的使用之间的关联.
- 使用概率比率测试对组间差异 (相互作用) 的探索性分析.
结论:
- 这项关于CLASSIC RCT的二次研究旨在提供对实践变化的见解.
- 了解与IV专素的使用相关的因素,可以为临床实践指南提供信息.
- 进一步的研究可能会澄清在败血症冲击管理中最佳使用白蛋白.
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