切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (03) : 184 -188. doi: 10.3877/cma.j.jssn.2096-1537.2016.03.010

所属专题: 重症医学 文献

观点

-正方观点-早期目标指导治疗:不应全盘否定其意义及作用
王陆豪, 欧阳彬, 管向东   
  • 收稿日期:2016-07-18 出版日期:2016-08-28
  • 通信作者: 管向东

Early goal directed therapy: couldn′t be not fully denied

Luhao Wang, Bin Ouyang, Xiangdong Guan   

  • Received:2016-07-18 Published:2016-08-28
  • Corresponding author: Xiangdong Guan
  • About author:
    Corresponding author: Guan Xiangdong, Email:
引用本文:

王陆豪, 欧阳彬, 管向东. -正方观点-早期目标指导治疗:不应全盘否定其意义及作用[J/OL]. 中华重症医学电子杂志, 2016, 02(03): 184-188.

Luhao Wang, Bin Ouyang, Xiangdong Guan. Early goal directed therapy: couldn′t be not fully denied[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(03): 184-188.

早期目标指导治疗(early goal directed therapy,EGDT)近年来受到不断质疑,针对其的三项研究ProCESS、ProMISe、ARISE结果均指向EGDT应被推翻。然而EGDT多年来推广和执行效果有目共睹,有效地降低了脓毒症患者的病死率;这三项大型研究其本身也存在着问题,并不能完全否定EGDT;我们正确地理解EGDT,在EGDT理念的基础上对其监测进行更新,才更有利益感染性休克患者的治疗。EGDT不应被抛弃,而应该进一步发展和更新。

Early goal-directed therapy had been doubted since it was reported 2001, and recently the trio of EGDT trials (ProCESS, ProMISe and ARISE) proved EDGT did not have positive effect and EGDT should not be recommended. However, the trio of EGDT trials themself had their own problem, they could not totally overthrow EGDT. Moreover, since EGDT was published and SSC bundle wide spread all over the world, it decreased the mortality of sepsis significantly. So we should understand EGDT correctly, knowing its core was the idea of early active resuscitated and updated its parameters, which could more conducive to patient with sepsis. EGDT should not be abandoned.

表1 近年来主要研究前后脓毒症及感染性休克患者病死率变化
表2 方法学上的差异
[1]
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19):1368–1377.
[2]
Nguyen HB, Jaehne AK, Jayaprakash N, et al. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE[J]. Critical Care, 2016, 20(1):10.
[3]
Kaukonen KM, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012[J]. JAMA, 2014, 311(13):1308–1316.
[4]
Pro CI, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock[J]. N Engl J Med, 2014, 370(18):1683–1693.
[5]
Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock[J]. N Engl J Med, 2015, 372(14):1301–1311.
[6]
Investigators A, Group ACT, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock[J]. N Engl J Med, 2014, 371(16):1496–1506.
[7]
Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA, 2016, 315(8):775–787.
[8]
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[J]. Crit Care Med, 2007, 35(5):1244–1250.
[9]
Ani C, Farshidpanah S, Bellinghausen SA, et al. Variations in organism-specific severe sepsis mortality in the United States: 1999-2008[J]. Crit Care Med, 2015, 43(1):65–77.
[10]
Stevenson EK, Rubenstein AR, Radin GT, et al. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*[J]. Crit Care Med, 2014, 42(3):625–631.
[11]
Kumar G, Kumar N, Taneja A, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007)[J]. Chest, 2011, 140(5):1223–1231.
[12]
Castellanos-Ortega A, Suberviola B, Garcia-Astudillo LA, et al. Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study[J]. Crit Care Med, 2010, 38(4):1036–1043.
[13]
Laguna-Pérez A, Chilet-Rosell E, Delgado Lacosta M, et al. Clinical pathway intervention compliance and effectiveness when used in the treatment of patients with severe sepsis and septic shock at an intensive care unit in Spain[J]. Rev Lat Am Enfermagem, 2012, 20(4):635–643.
[14]
Memon JI, Rehmani RS, Alaithan AM, et al. Impact of 6-hour sepsis resuscitation bundle compliance on hospital mortality in a saudi hospital[J]. Crit Care Res Pract, 2012, 2012:273268.
[15]
Shiramizo SC, Marra AR, Durao MS, et al. Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting[J]. PLoS One, 2011, 6(11):e26790.
[16]
Hanzelka KM, Yeung SC, Chisholm G, et al. Implementation of modified early-goal directed therapy for sepsis in the emergency center of a comprehensive cancer center[J]. Support Care Cancer, 2013, 21(3):727–734.
[17]
Jeon K, Shin TG, Sim MS, et al. Improvements in compliance with resuscitation bundles and achievement of end points after an educational program on the management of severe sepsis and septic shock[J]. Shock, 2012, 37(5):463–467.
[18]
Kang MJ, Shin TG, Jo IJ, et al. Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock[J]. Shock, 2012, 38(5):474–479.
[19]
Kortgen A, Niederprum P, Bauer M. Implementation of an evidence-based ʺstandard operating procedureʺ and outcome in septic shock[J]. Crit Care Med, 2006, 34(4):943–949.
[20]
Mikkelsen ME, Gaieski DF, Goyal M, et al. Factors associated with nonadherence to early goal-directed therapy in the ED[J]. Chest, 2010, 138(3):551–558.
[21]
Sivayoham N, Rhodes A, Jaiganesh T, et al. Outcomes from implementing early goal-directed therapy for severe sepsis and septic shock: a 4-year observational cohort study[J]. Eur J Emerg Med, 2012, 19(4):235–240.
[22]
Thiel SW, Asghar MF, Micek ST, et al. Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis[J]. Crit Care Med, 2009, 37(3):819–824.
[23]
Tromp MB-RC, van Achterberg T, Kullberg BJ, et al. Internal medicine residents' knowledge about sepsis: effects of a teaching intervention[J]. Neth J Med, 2009, 67(9):312–315.
[24]
Trzeciak S, Dellinger RP, Abate NL, et al. Translating research to clinical practice: a 1-year experience with implementing early goal-directed therapy for septic shock in the emergency department[J]. Chest, 2006, 129(2):225–232.
[25]
Wawrzeniak IC, Loss SH, Moraes MC, et al. Could a protocol based on early goal-directed therapy improve outcomes in patients with severe sepsis and septic shock in the Intensive Care Unit setting?[J] Indian J Crit Care Med, 2015, 19(3):159–165.
[26]
Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial[J]. JAMA, 2010, 303(8):739–746.
[27]
浙江省早期规范化液体复苏治疗协作组. 危重病严重脓毒症/脓毒性休克患者早期规范化液体复苏治疗——多中心、前瞻性、随机、对照研究[J]. 中国危重病急救医学, 2010, 22(6):331–334.
[28]
陈仲清,金英慧,陈辉,等. 早起目标指导治疗对多器官功能障碍综合征发病率、严重度及病死率的影响[J]. 南方医科大学学报, 2007, 27(12):1892–1895
[29]
何征宇, 皋源, 王祥瑞, 等. 早期目标导向治疗在感染性休克中应用的临床探讨[J]. 中国危重病急救医学, 2007, 19(1):14–16.
[30]
王晓芝, 吕长俊, 高福全, 等. 目标指导下治疗脓毒性休克的疗效观察[J]. 中国危重病急救医学, 2006, 18(11):661–664.
[31]
Lin SM, Huang CD, Lin HC, et al. A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: a randomized controlled trial[J]. Shock, 2006, 26(6):551–557.
[32]
Yan J, Cai G. A multicentre study on early goal-directed therapy of severe sepsis and septic shock patients in the ICU: collaborative study group on early goal-directed therapy in Zhejiang Province, China[J]. Critical Care, 2008, 12(Suppl 2):P417.
[33]
Padkin A, Goldfrad C, Brady AR, et al. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland[J]. Crit Care Med, 2003, 31(9):2332–2338.
[34]
Gao F, Melody T, Daniels DF, et al. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study[J]. Crit Care, 2005, 9(6):R764–770.
[35]
Reuben AD, Appelboam AV, Higginson I. The outcomes of severe sepsis and septic shock in the UK[J]. Crit Care, 2006, 10(4):417.
[36]
Melville J, Ranjan S, Morgan P. ICU mortality rates in patients with sepsis before and after the Surviving Sepsis Campaign[J]. Critical Care, 2015, 19(Suppl 1):P15.
[37]
Daniels R, Nutbeam T, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study[J]. Emerg Med J, 2011, 28(6):507–512.
[38]
Finfer S, Bellomo R, Lipman J, et al. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units[J]. Intensive Care Med, 2004, 30(4):589–596.
[39]
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients[J]. N Engl J Med, 2001, 345(19):1359–1367.
[40]
Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock[J]. Jama, 2002, 288(7):862–871.
[41]
Vincent JL. We should abandon randomized controlled trials in the intensive care unit[J]. Crit Care Med, 2010, 38(10 Suppl):S534–538.
[42]
Boulain T, Garot D, Vignon P, et al. Prevalence of low central venous oxygen saturation in the first hours of intensive care unit admission and associated mortality in septic shock patients: a prospective multicentre study[J]. Crit Care, 2014, 18(6):609.
[43]
Tiruvoipati R, Ong K, Gangopadhyay H, et al. Hypothermia predicts mortality in critically ill elderly patients with sepsis[J]. BMC Geriatr, 2010, 10:70.
[44]
Kumar A, Ellis P, Arabi Y, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock[J]. Chest, 2009, 136(5):1237–1248.
[45]
Chalfin DB, Trzeciak S, Likourezos A, et al. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit[J]. Crit Care Med, 2007, 35(6):1477–1483.
[46]
Lee SJ, Ramar K, Park JG, et al. Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study[J]. Chest, 2014, 146(4):908–915.
[47]
Liu VX, Morehouse JW, Marelich GP, et al. Multicenter Implementation of a Treatment Bundle for Patients with Sepsis and Intermediate Lactate Values[J]. Am J Respir Crit Care Med, 2016, 193(11):1264–1270.
[48]
Samuel A, Marc S, Mike H, et al. Utilizing Electronic Alerts And IVC Ultrasound To Improve Outcomes For Sepsis Care In An Urban ED[A]. In: B37. QUALITY IMPROVEMENT IN PULMONARY AND CRITICAL CARE MEDICINE: American Thoracic Society, 2014: A2817–A2817.
[49]
Levy MM, Rhodes A, Phillips GS, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study[J]. Intensive Care Med, 2014, 40(11):1623–1633.
[50]
Rhodes A, Phillips G, Beale R, et al. The surviving sepsis campaign bundles and outcome: results from the international multicentre prevalence study on sepsis (the IMPreSS study)[J]. Intensive Care Med, 2015, 41(9):1620–1628.
[51]
Marik PE. The demise of early goal-directed therapy for severe sepsis and septic shock[J]. Acta Anaesthesiol Scand, 2015, 59(5):561–567.
[52]
Sharif S, Owen JJ, Upadhye S. The end of early-goal directed therapy?[J] Am J Emerg Med, 2016, 34(2):292–294.
[53]
Shippy CR, Appel PL, Shoemaker WC. Reliability of clinical monitoring to assess blood volume in critically ill patients[J]. Crit Care Med, 1984, 12(2):107–112.
[54]
Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1):172–178.
[55]
Angus DC, Barnato AE, Bell D, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators[J]. Intensive Care Med, 2015, 41(9):1549–1560.
[1] 农云洁, 黄小桂, 黄裕兰, 农恒荣. 超声在多重肺部感染诊断中的临床应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 872-876.
[2] 李小飞, 刘洪莉, 石丘玲, 田静, 李莉, 漆洪波, 罗欣. 自然分娩产妇低强度聚焦超声子宫复旧治疗防治产后出血的前瞻性随机对照研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 534-539.
[3] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[4] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[5] 皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[6] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[7] 臧宇, 姚胜, 朱新勇, 戎世捧, 田智超. 低温等离子射频消融治疗腹壁疝术后补片感染的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 687-692.
[8] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[9] 胡菊英, 李银华, 洪兰, 王宏勇, 丁先军, 李承美, 谭心海. 儿童感染大叶性肺炎与支气管肺炎临床特征分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 813-816.
[10] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[11] 丛黎, 马林, 陈旭, 李文文, 张亮亮, 周华亭. 改良CT严重指数联合炎症指标在重症急性胰腺炎患者胰腺感染预测及预后评估中的研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 432-436.
[12] 陈惠英, 邱敏珊, 邵汉权. 脓毒症诱发肠黏膜屏障功能损伤的风险因素模型构建与应用效果[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 448-452.
[13] 贾玲玲, 滕飞, 常键, 黄福, 刘剑萍. 心肺康复在各种疾病中应用的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 859-862.
[14] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[15] 董晟, 郎胜坤, 葛新, 孙少君, 薛明宇. 反向休克指数乘以格拉斯哥昏迷评分对老年严重创伤患者发生急性创伤性凝血功能障碍的预测价值[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 541-547.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?