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>Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials
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Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials
BACKGROUND:Although the resuscitation of an adult trauma patient has been researched and written about for the past century, the ideal fluid strategy to infuse during the initial resuscitation period remains unresolved. This work was aimed at assessing the effect of hypotensive versus conventional resuscitation strategies in traumatic hemorrhagic shock patients on mortality, and the need for blood transfusions including adverse events.METHODS:This systematic review and meta-analysis were performed following the PRISMA guidelines. Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of hypotension versus conventional fluid resuscitation for traumatic hemorrhagic shock patients. Two reviewers independently performed the screening, data extraction, and bias assessment. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.4.RESULTS:Data from 28 RCTs on 4503 patients were included in the final meta-analysis. Patients receiving hypotension fluid resuscitation compared with conventional fluid resuscitation experienced less mortality (12.5% vs. 21.4%; RR = 0.58; 95% CI: 0.51-0.66; p 0.001), fewer adverse events (10.8% vs. 13.4%; RR = 0.70; 95% CI: 0.59-0.83; p 0.001), including fever acute respiratory distress syndrome (7.8% vs. 16.8%) or multiple organ dysfunction syndrome (8.6% vs. 21.6%).CONCLUSIONS:This meta-analysis showed that hypotensive fluid resuscitation significantly reduced the mortality of hypovolemic shock patients. Findings are low in certainty and should be interpreted with caution. Therefore, there is an urgent need for larger, multicenter, randomized trials to confirm these findings.
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机译:背景:虽然过去世纪已研究和编写成年人创伤患者的复苏,但在初始复苏期间注入的理想流体策略仍未解决。这项工作旨在评估对创伤性失血性休克患者对死亡率的低脉冲与传统复苏策略的影响,以及对包括不良事件的血液输血的需求。方法:在PRISMA准则之后进行这种系统审查和荟萃分析。搜索了电子数据库的随机对照试验(RCT)比较了低血压与常规流体复苏对创伤性出血休克患者的影响。两位审阅者独立地进行了筛选,数据提取和偏见评估。使用Cochrane Collaboration的软件Revman 5.4完成数据分析。结果:来自4503名患者的28名RCT的数据被列入最终的Meta分析中。接受低血压流体复苏的患者与常规流体复苏相比经历了较少的死亡率(12.5%与21.4%; RR = 0.58; 95%CI:0.51-0.66; P <0.001),不良事件较少(10.8%与13.4%; RR = 0.70; 95%CI:0.59-0.83; p <0.001),包括发烧急性呼吸窘迫综合征(7.8%vs.16.8%)或多器官功能障碍综合征(8.6%与21.6%)。结论:此元分析显示低血压流体复苏显着降低了缓血休克患者的死亡率。调查结果肯定低,应该谨慎解释。因此,迫切需要更大,多中心,随机试验来确认这些发现。
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