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.	卢年芳, 郑瑞强, 林华, 等. PICCO 指导下集束化治疗感染性休克的临床研究. 中华危重病急救医学, 2014, 26(1): 23-27.
8.	吴立春. PICCO监测在感染休克早期液体复苏中的应用研究. 中国当代医药, 2014, 21(28): 43-45.
9.	张汝敏, 王世富, 马爽, 等. PICCO 技术优化脓毒性休克患者 EGDT 的效果. 中华麻醉学杂志, 2014, 34(6): 739-742.
10.	何峻, 吕爱莲, 戴瑶, 等. PICCO 监测对指导脓毒性休克患者液体复苏治疗的价值. 中国临床研究, 2016, 29(11): 1466-1469.
11.	古伟升, 李敏. 血流动力学监测技术在脓毒性休克患者中的应用及护理. 护理实践与研究, 2014, 11(8): 28-30.
12.	陈晓雷. PICCO 监测技术指导感染性休克患者液体复苏的临床研究. 医药前沿, 2016, 6(34): 107-108.
13.	陆俊. PICCO 监测联合血乳酸及乳酸清除率对感染性休克患者预后影响的研究. 武汉: 华中科技大学, 2015.
14.	李文杰. PICCO 监护仪对感染性休克治疗的指导意义. 河北医药, 2011, 33(15): 2306-2307.
15.	柳金玲. PICCO 容量监测指导脓毒性休克早期液体复苏的临床研究. 昆明: 昆明医科大学, 2015.
16.	伍义, 马月丹, 吴寿坤. PICCO 容量性指标在感染性休克液体复苏中的临床应用. 现代中西医结合杂志, 2013, 22(1): 16-17.
17.	陆通安, 苏丽娟. 在 PICCO 监测下对感染性休克患者进行早期液体复苏的效果探析. 当代医药论丛, 2015, 13(12): 269-270.
18.	陈军, 刘艳艳, 温振杰. PICCO 在脓毒性休克患者早期液体复苏治疗中的有效性探究. 现代诊断与治疗, 2015, 26(12): 2771-2772.
19.	刘建凌, 张明, 温振杰, 等. 脉搏指示连续心排血量监测对脓毒症休克液体复苏的指导价值. 中国医药导报, 2016, 13(8): 120-123.
20.	唐坎凯, 温晓红, 董朝晖, 等. 感染性休克患者 PICCO 指导早期液体复苏的临床研究. 中华急诊医学杂志, 2012, 21(9): 1039-1041.
21.	胡健, 尚为明, 程冲, 等. 脉搏指示连续心排血量监测技术优化脓毒性休克患者早期目标指导治疗的效果研究. 中国处方药, 2015, 13(7): 101-102.
22.	邵东风, 张立坤, 高景利, 等. 探讨和分析 PICCO 容量性指标在感染性休克液体复苏中的应用价值. 医学信息, 2014, 27(7): 438-439.
23.	唐宇涛, 俞宁. 脉搏指示连续心输出量监测在感染性休克患者早期液体复苏中的临床价值. 检验医学与临床, 2015, 12(11): 1508-1510.
24.	吴伟东, 张涛. 舒建胜. 脉搏指数连续心排血量监测在脓毒性休克早期液体复苏中的应用. 全科医学临床与教育, 2013, 11(6): 631-633.
25.	刘素霞, 石远峰, 陈晓兵, 等. 全心舒张末期容积指数在脓毒性休克早期液体复苏中的应用. 中华灾害救援医学, 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. 卢年芳, 郑瑞强, 林华, 等. PICCO 指导下集束化治疗感染性休克的临床研究. 中华危重病急救医学, 2014, 26(1): 23-27.
8. 吴立春. PICCO监测在感染休克早期液体复苏中的应用研究. 中国当代医药, 2014, 21(28): 43-45.
9. 张汝敏, 王世富, 马爽, 等. PICCO 技术优化脓毒性休克患者 EGDT 的效果. 中华麻醉学杂志, 2014, 34(6): 739-742.
10. 何峻, 吕爱莲, 戴瑶, 等. PICCO 监测对指导脓毒性休克患者液体复苏治疗的价值. 中国临床研究, 2016, 29(11): 1466-1469.
11. 古伟升, 李敏. 血流动力学监测技术在脓毒性休克患者中的应用及护理. 护理实践与研究, 2014, 11(8): 28-30.
12. 陈晓雷. PICCO 监测技术指导感染性休克患者液体复苏的临床研究. 医药前沿, 2016, 6(34): 107-108.
13. 陆俊. PICCO 监测联合血乳酸及乳酸清除率对感染性休克患者预后影响的研究. 武汉: 华中科技大学, 2015.
14. 李文杰. PICCO 监护仪对感染性休克治疗的指导意义. 河北医药, 2011, 33(15): 2306-2307.
15. 柳金玲. PICCO 容量监测指导脓毒性休克早期液体复苏的临床研究. 昆明: 昆明医科大学, 2015.
16. 伍义, 马月丹, 吴寿坤. PICCO 容量性指标在感染性休克液体复苏中的临床应用. 现代中西医结合杂志, 2013, 22(1): 16-17.
17. 陆通安, 苏丽娟. 在 PICCO 监测下对感染性休克患者进行早期液体复苏的效果探析. 当代医药论丛, 2015, 13(12): 269-270.
18. 陈军, 刘艳艳, 温振杰. PICCO 在脓毒性休克患者早期液体复苏治疗中的有效性探究. 现代诊断与治疗, 2015, 26(12): 2771-2772.
19. 刘建凌, 张明, 温振杰, 等. 脉搏指示连续心排血量监测对脓毒症休克液体复苏的指导价值. 中国医药导报, 2016, 13(8): 120-123.
20. 唐坎凯, 温晓红, 董朝晖, 等. 感染性休克患者 PICCO 指导早期液体复苏的临床研究. 中华急诊医学杂志, 2012, 21(9): 1039-1041.
21. 胡健, 尚为明, 程冲, 等. 脉搏指示连续心排血量监测技术优化脓毒性休克患者早期目标指导治疗的效果研究. 中国处方药, 2015, 13(7): 101-102.
22. 邵东风, 张立坤, 高景利, 等. 探讨和分析 PICCO 容量性指标在感染性休克液体复苏中的应用价值. 医学信息, 2014, 27(7): 438-439.
23. 唐宇涛, 俞宁. 脉搏指示连续心输出量监测在感染性休克患者早期液体复苏中的临床价值. 检验医学与临床, 2015, 12(11): 1508-1510.
24. 吴伟东, 张涛. 舒建胜. 脉搏指数连续心排血量监测在脓毒性休克早期液体复苏中的应用. 全科医学临床与教育, 2013, 11(6): 631-633.
25. 刘素霞, 石远峰, 陈晓兵, 等. 全心舒张末期容积指数在脓毒性休克早期液体复苏中的应用. 中华灾害救援医学, 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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