Efficacy of pulse indicating continuous cardiac output monitoring on the treatment guidance of patients with septic shock: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Yuhan ¹ ,  SHEN Xiaoxu ² , JIANG Qimin ³ , CAI Yangping ³ , GUO Nan ³ , ZHAO Hongfang ³

1. Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, P.R.China;
2. Department of CCU, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, P.R.China;
3. Department of ICU, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, P.R.China;

Corresponding?author：

SHEN Xiaoxu, Email: ghxiaoxushen@sina.com

Keywords：

Pulse indicating continuous cardiac output monitoring (PICCO); Septic shock; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201703021

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ObjectiveTo systematically review the efficacy of pulse indicating continuous cardiac output (PICCO) monitoring for guiding the treatment of patients with septic shock.MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, CBM, WanFang Data, VIP and CNKI were electronically searched from inception to February 2017 to collect randomized controlled trials (RCTs) about PICCO monitoring on treatment guidance of patients with septic shock. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software.ResultsA total of 20 RCTs involving 1 253 patients were included. The results of meta-analysis showed: compared with central venous pressure (CVP) measurements, the treatment of sepsis bundles informed by PICCO could significantly shorten the length of intensive care unit (ICU) stay (MD=–2.74, 95%CI –3.40 to –2.09, P<0.001), reduce the ICU mortality (RR=0.49, 95%CI 0.36 to 0.67, P<0.001) and 28-day mortality (RR=0.61, 95%CI 0.43 to 0.87, P=0.006).ConclusionCurrent evidence shows the PICCO monitoring can significantly improve the prognosis of septic shock. Due to limited and quantity quality of the included studies, more high-quality studies are needed to verify above conclusion.

Citation： ZHU Yuhan, SHEN Xiaoxu, JIANG Qimin, CAI Yangping, GUO Nan, ZHAO Hongfang. Efficacy of pulse indicating continuous cardiac output monitoring on the treatment guidance of patients with septic shock: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(8): 934-940. doi: 10.7507/1672-2531.201703021 Copy

1.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
2.	Litton E, Morgan M. The PICCO monitor: a review. Anaesth Intensive Care, 2012, 40 (3): 393-409.
3.	Zhang Z, Ni H, Qian Z. Effectiveness of treatment based on PICCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med, 2015, 41(3): 444-451.
4.	Zhang Z, Lu B, Ni H. Prognostic value of extravascular lung water index in critically ill patients: a systematic review of the literature. J Crit Care, 2012, 27(420): 421-428.
5.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Available at: http://www. cochrane-handbook.org.
6.	Lu NF, Zheng RQ, Lin H, et al. Improved sepsis bundles in the treatment of septic shock: a prospective clinical study. Am J of Emerg Med, 2015, 33(8): 1045-1049.
7.	盧年芳, 鄭瑞強, 林華, 等. PICCO 指導下集束化治療感染性休克的臨床研究. 中華危重病急救醫學, 2014, 26(1): 23-27.
8.	吳立春. PICCO監測在感染休克早期液體復蘇中的應用研究. 中國當代醫藥, 2014, 21(28): 43-45.
9.	張汝敏, 王世富, 馬爽, 等. PICCO 技術優化膿毒性休克患者 EGDT 的效果. 中華麻醉學雜志, 2014, 34(6): 739-742.
10.	何峻, 呂愛蓮, 戴瑤, 等. PICCO 監測對指導膿毒性休克患者液體復蘇治療的價值. 中國臨床研究, 2016, 29(11): 1466-1469.
11.	古偉升, 李敏. 血流動力學監測技術在膿毒性休克患者中的應用及護理. 護理實踐與研究, 2014, 11(8): 28-30.
12.	陳曉雷. PICCO 監測技術指導感染性休克患者液體復蘇的臨床研究. 醫藥前沿, 2016, 6(34): 107-108.
13.	陸俊. PICCO 監測聯合血乳酸及乳酸清除率對感染性休克患者預后影響的研究. 武漢: 華中科技大學, 2015.
14.	李文杰. PICCO 監護儀對感染性休克治療的指導意義. 河北醫藥, 2011, 33(15): 2306-2307.
15.	柳金玲. PICCO 容量監測指導膿毒性休克早期液體復蘇的臨床研究. 昆明: 昆明醫科大學, 2015.
16.	伍義, 馬月丹, 吳壽坤. PICCO 容量性指標在感染性休克液體復蘇中的臨床應用. 現代中西醫結合雜志, 2013, 22(1): 16-17.
17.	陸通安, 蘇麗娟. 在 PICCO 監測下對感染性休克患者進行早期液體復蘇的效果探析. 當代醫藥論叢, 2015, 13(12): 269-270.
18.	陳軍, 劉艷艷, 溫振杰. PICCO 在膿毒性休克患者早期液體復蘇治療中的有效性探究. 現代診斷與治療, 2015, 26(12): 2771-2772.
19.	劉建凌, 張明, 溫振杰, 等. 脈搏指示連續心排血量監測對膿毒癥休克液體復蘇的指導價值. 中國醫藥導報, 2016, 13(8): 120-123.
20.	唐坎凱, 溫曉紅, 董朝暉, 等. 感染性休克患者 PICCO 指導早期液體復蘇的臨床研究. 中華急診醫學雜志, 2012, 21(9): 1039-1041.
21.	胡健, 尚為明, 程沖, 等. 脈搏指示連續心排血量監測技術優化膿毒性休克患者早期目標指導治療的效果研究. 中國處方藥, 2015, 13(7): 101-102.
22.	邵東風, 張立坤, 高景利, 等. 探討和分析 PICCO 容量性指標在感染性休克液體復蘇中的應用價值. 醫學信息, 2014, 27(7): 438-439.
23.	唐宇濤, 俞寧. 脈搏指示連續心輸出量監測在感染性休克患者早期液體復蘇中的臨床價值. 檢驗醫學與臨床, 2015, 12(11): 1508-1510.
24.	吳偉東, 張濤. 舒建勝. 脈搏指數連續心排血量監測在膿毒性休克早期液體復蘇中的應用. 全科醫學臨床與教育, 2013, 11(6): 631-633.
25.	劉素霞, 石遠峰, 陳曉兵, 等. 全心舒張末期容積指數在膿毒性休克早期液體復蘇中的應用. 中華災害救援醫學, 2016, 4(12): 692-694.
26.	Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med, 2010, 36(2): 222-231.
27.	Annane D, Aegerter P, Jars-Guincestre MC, et al. Network CU-R. Current epidemiology of septic shock: the CUB-REA network. Am J Respir Crit Care Med, 2003, 168(2): 165-172.
28.	Dombrovskiy VY, Martin AA, Sunderram J, et al. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med, 2007, 35(5): 1244-1250.
29.	Miller RR 3rd, Dong L, Nelson NC, et al. Multicenter implementation of a severe sepsis and septic shock treatment bundle. Am J Respir Crit Care Med, 2013, 188(1): 77-82.
30.	Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patient. Chest, 2002, 122(6): 2080-2086.
31.	López-Herce J, Bustinza A, Sancho L, et al. Cardiac output and blood volume parameters using femoral arterial thermodilution. Pediatr Int, 2009, 51(1): 59-65.

1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
2. Litton E, Morgan M. The PICCO monitor: a review. Anaesth Intensive Care, 2012, 40 (3): 393-409.
3. Zhang Z, Ni H, Qian Z. Effectiveness of treatment based on PICCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med, 2015, 41(3): 444-451.
4. Zhang Z, Lu B, Ni H. Prognostic value of extravascular lung water index in critically ill patients: a systematic review of the literature. J Crit Care, 2012, 27(420): 421-428.
5. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Available at: http://www. cochrane-handbook.org.
6. Lu NF, Zheng RQ, Lin H, et al. Improved sepsis bundles in the treatment of septic shock: a prospective clinical study. Am J of Emerg Med, 2015, 33(8): 1045-1049.
7. 盧年芳, 鄭瑞強, 林華, 等. PICCO 指導下集束化治療感染性休克的臨床研究. 中華危重病急救醫學, 2014, 26(1): 23-27.
8. 吳立春. PICCO監測在感染休克早期液體復蘇中的應用研究. 中國當代醫藥, 2014, 21(28): 43-45.
9. 張汝敏, 王世富, 馬爽, 等. PICCO 技術優化膿毒性休克患者 EGDT 的效果. 中華麻醉學雜志, 2014, 34(6): 739-742.
10. 何峻, 呂愛蓮, 戴瑤, 等. PICCO 監測對指導膿毒性休克患者液體復蘇治療的價值. 中國臨床研究, 2016, 29(11): 1466-1469.
11. 古偉升, 李敏. 血流動力學監測技術在膿毒性休克患者中的應用及護理. 護理實踐與研究, 2014, 11(8): 28-30.
12. 陳曉雷. PICCO 監測技術指導感染性休克患者液體復蘇的臨床研究. 醫藥前沿, 2016, 6(34): 107-108.
13. 陸俊. PICCO 監測聯合血乳酸及乳酸清除率對感染性休克患者預后影響的研究. 武漢: 華中科技大學, 2015.
14. 李文杰. PICCO 監護儀對感染性休克治療的指導意義. 河北醫藥, 2011, 33(15): 2306-2307.
15. 柳金玲. PICCO 容量監測指導膿毒性休克早期液體復蘇的臨床研究. 昆明: 昆明醫科大學, 2015.
16. 伍義, 馬月丹, 吳壽坤. PICCO 容量性指標在感染性休克液體復蘇中的臨床應用. 現代中西醫結合雜志, 2013, 22(1): 16-17.
17. 陸通安, 蘇麗娟. 在 PICCO 監測下對感染性休克患者進行早期液體復蘇的效果探析. 當代醫藥論叢, 2015, 13(12): 269-270.
18. 陳軍, 劉艷艷, 溫振杰. PICCO 在膿毒性休克患者早期液體復蘇治療中的有效性探究. 現代診斷與治療, 2015, 26(12): 2771-2772.
19. 劉建凌, 張明, 溫振杰, 等. 脈搏指示連續心排血量監測對膿毒癥休克液體復蘇的指導價值. 中國醫藥導報, 2016, 13(8): 120-123.
20. 唐坎凱, 溫曉紅, 董朝暉, 等. 感染性休克患者 PICCO 指導早期液體復蘇的臨床研究. 中華急診醫學雜志, 2012, 21(9): 1039-1041.
21. 胡健, 尚為明, 程沖, 等. 脈搏指示連續心排血量監測技術優化膿毒性休克患者早期目標指導治療的效果研究. 中國處方藥, 2015, 13(7): 101-102.
22. 邵東風, 張立坤, 高景利, 等. 探討和分析 PICCO 容量性指標在感染性休克液體復蘇中的應用價值. 醫學信息, 2014, 27(7): 438-439.
23. 唐宇濤, 俞寧. 脈搏指示連續心輸出量監測在感染性休克患者早期液體復蘇中的臨床價值. 檢驗醫學與臨床, 2015, 12(11): 1508-1510.
24. 吳偉東, 張濤. 舒建勝. 脈搏指數連續心排血量監測在膿毒性休克早期液體復蘇中的應用. 全科醫學臨床與教育, 2013, 11(6): 631-633.
25. 劉素霞, 石遠峰, 陳曉兵, 等. 全心舒張末期容積指數在膿毒性休克早期液體復蘇中的應用. 中華災害救援醫學, 2016, 4(12): 692-694.
26. Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med, 2010, 36(2): 222-231.
27. Annane D, Aegerter P, Jars-Guincestre MC, et al. Network CU-R. Current epidemiology of septic shock: the CUB-REA network. Am J Respir Crit Care Med, 2003, 168(2): 165-172.
28. Dombrovskiy VY, Martin AA, Sunderram J, et al. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med, 2007, 35(5): 1244-1250.
29. Miller RR 3rd, Dong L, Nelson NC, et al. Multicenter implementation of a severe sepsis and septic shock treatment bundle. Am J Respir Crit Care Med, 2013, 188(1): 77-82.
30. Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patient. Chest, 2002, 122(6): 2080-2086.
31. López-Herce J, Bustinza A, Sancho L, et al. Cardiac output and blood volume parameters using femoral arterial thermodilution. Pediatr Int, 2009, 51(1): 59-65.

Chinese Journal of Evidence-Based Medicine

Efficacy of pulse indicating continuous cardiac output monitoring on the treatment guidance of patients with septic shock: a meta-analysis

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