Clinical parameter‐guided initial resuscitation in adult patients with septic shock: A systematic review and network meta‐analysis

• Published in: Acute medicine & surgery 2023-01, Vol.10 (1), p.e914-n/a
• Main Authors: Yumoto, Tetsuya, Kuribara, Tomoki, Yamada, Kohei, Sato, Takehito, Koba, Shigeru, Tetsuhara, Kenichi, Kashiura, Masahiro, Sakuraya, Masaaki
• Format: Article
• Language: English
• Subjects: Bias; capillary refill timecarbon dioxide gapcentral venous oxygen saturationlactatenetwork meta‐analysissepsisseptic shock; Carbon dioxide; Hospitals; Intensive care; Length of stay; Meta-analysis; Mortality; Original; Oxygen saturation; Pneumonia; Sepsis; Ventilators; Web portals
• ISSN: 2052-8817; 2052-8817
• DOI: 10.1002/ams2.914

Aim To identify the most useful tissue perfusion parameter for initial resuscitation in sepsis/septic shock adults using a network meta‐analysis. Methods We searched major databases until December 2022 for randomized trials comparing four tissue perfusion parameters or against usual care. The primary outcome was short‐term mortality up to 90 days. The Confidence in Network Meta‐Analysis web application was used to assess the quality of evidence. Results Seventeen trials were identified. Lactate‐guided therapy (risk ratios, 0.59; 95% confidence intervals [0.45–0.76]; high certainty) and capillary refill time‐guided therapy (risk ratios, 0.53; 95% confidence intervals [0.33–0.86]; high certainty) were significantly associated with lower short‐term mortality compared with usual care, whereas central venous oxygen saturation‐guided therapy (risk ratio, 1.50; 95% confidence intervals [1.16–1.94]; moderate certainty) increased the risk of short‐term mortality compared with lactate‐guided therapy. Conclusions Lactate or capillary refill time‐guided initial resuscitation for sepsis/septic shock patients may decrease short‐term mortality. More research is essential to personalize and optimize treatment strategies for septic shock resuscitation. In this network meta‐analysis involving 17 studies with 6850 participants across five interventions, lactate or capillary refill time‐guided resuscitation showed significantly lower mortality up to 90 days in adults with sepsis or septic shock compared to usual care, whereas ScvO2‐guided therapy had a higher mortality risk than lactate‐guided therapy.