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地缘经济影响流体体积对败血症复苏的影响:一个元分析
Ségolène Gendreau1,2, Thomas Frapard1,2, Guillaume Carteaux1,2,3
1Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Medecine Intensive Réanimation, Créteil, France.
American journal of respiratory and critical care medicine
|January 23, 2024
概括
败血症管理中的液体复苏对死亡率的影响因国家收入而异. 较高的流体量增加了低收入和中等收入国家的死亡率,与高收入国家不同.
科学领域:
- 关键护理医学 关键护理医学
- 全球健康 全球健康
- 临床试验 临床试验
背景情况:
- 败血症的治疗需要仔细的液体复苏,以防止过载和器官拥堵.
- 液体管理风险和益处的平衡在不同的医疗保健环境中可能会有所不同.
研究的目的:
- 调查国家收入水平如何影响败血症患者流体管理策略的风险效益平衡.
- 分析液体复苏量对低收入和中等收入国家 (LMICs) 与高收入国家 (HICs) 的死亡率和资源利用率的影响差异.
主要方法:
- 进行了随机对照试验 (RCT) 关于在败血症或败血症休克时的液体复苏的元分析,不包括特定的液体类型和干预措施.
- 分析了29项涉及11,798名患者的研究,比较了较高与较低的液体体积策略.
- 结果按国家收入组 (LMICs vs. HICs) 和机械通风的使用情况进行了分层.
主要成果:
- 较高的流体量与LMICs (OR,1.47;95% CI:1.14-1.90) 的死亡率增加有关,但与HICs (OR,1.00;95% CI:0.87-1.16;P=0.01) 的死亡率增加无关.
- 在LMICs (OR,1.24;95% CI:1.08-1.43) 观察到增加机械通风的需要,而不是HICs (OR,1.02;95% CI:0.80-1.29).
- 较高的液体体积增加了死亡风险,主要是在机械通风机会有限的环境中 (OR: 1.45;95% CI: 1.09-1.93).
结论:
- 败血症中液体复苏策略的影响因环境而异,特别是根据国家收入水平和资源可用性而异.
- 较高的液体体积与LMIC和限制机械通风接入的环境中的死亡率增加有关.
- 这些差异的原因需要进一步调查,可能涉及资源限制,参与者特征或未测量的因素.
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