皮质类固醇用于治疗儿科败血症和败血性休克:系统性审查和元分析
Jiawen Deng1,2, Nefissa Bedri3, Qi Kang Zuo4
1From the Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
The Pediatric infectious disease journal
|September 30, 2024
概括
皮质类固醇可以减少儿科败血症和败血性休克的死亡率和住院时间. 然而,最佳使用和安全性需要进一步调查,因为证据质量不佳.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 药理学 药理学是指药理学的学科.
- 传染病 传染病 传染病
背景情况:
- 儿科败血症和败血性休克是危及生命的疾病,需要有效的管理.
- 皮质类固醇用于败血症,但它们在儿童中的有效性和安全性仍有争议.
- 需要综合证据来指导儿科败血症管理的临床实践.
研究的目的:
- 系统地审查和元分析儿童败血症和败血性休克中皮质类固醇使用的随机对照试验 (RCT).
- 评估皮质类固醇对儿科患者死亡率,停留时间和不良事件的影响.
- 评估儿童败血症皮质类固醇治疗的证据质量.
主要方法:
- 在多个数据库 (MEDLINE,Embase,CENTRAL,Web of Science,CNKI) 进行系统搜索,截至2023年9月.
- 包括16个RCT (N=973) 进行皮质类固醇与儿科败血症或全身炎症反应综合征的标准护理的比较.
- 提取有关死亡率,住院和PICU长度,休克持续时间和不良事件的数据;使用修订后的Cochrane工具评估偏差风险.
主要成果:
- 皮质类固醇使用显示出潜在的降低死亡率 (RR:0.65,95% CI:0.50-0.85).
- 较短的住院时间 (MD: -3.76天) 和PICU停留时间 (MD: -2.34天) 与皮质类固醇使用有关.
- 胃肠道出血是潜在的不良事件,但没有发现二次感染或严重不良事件的风险增加. 证据质量低至非常低.
结论:
- 皮质类固醇在儿科败血症和败血性休克中显示出潜在的益处,包括降低死亡率和缩短住院时间.
- 最佳的患者选择和皮质类固醇治疗方案需要进一步的研究.
- 未来的试验应优先评估与皮质类固醇相关的不良事件,并根据败血症亚表型对患者进行分层.
相关概念视频
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
97
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
97
Inflammatory Bowel Disease IV: Pharmacological Management
118
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
118
Pneumonia IV: Management
305
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
305
COPD: Management Using Bronchodilators and Corticosteroids
185
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
185
Myocarditis III: Medical Management
2
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
2
Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
226
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
226


