Meta-analysis Of The Effect Of Ultrasound And PICCO In The Treatment Of Septic Shock

Objective: To evaluate the effect of ultrasound and PICCO(Pulse indicated continuous cardiac output)in the treatment of sepsis shock.Methods: Literature retrieval.Literature retrieval from building to August 2019,the main databases of literature retrieval are Wanfang,VIP,How Net,Embase,Pubmed,China biomedical literature database and Cochrane Library.Chinese key words are sepsis,sepsis shock,ultrasound,PICCO(pulse indicating continuous cardiac output monitoring technology),pulse indicating continuous cardiac output monitoring technology,septic shock,randomized controlled trial,etc.English key words are pulse indicating continuous cardiac output,PICCO,sepsis,septic shock,random,etc.Two researchers independently screened the literature to determine the risk of bias for inclusion in the study,and then conducted meta-analysis based on Revman 5.3.Results: A total of 9 studies were included,including 668 patients,334 patients with Pi CCO and 334 patients with ultrasound.The bias evaluation tool of Cochrane Collaboration Network was used to evaluate the bias of the included literature.The meta analysis results showed that: the number of continuous renal replacement therapy(CRRT)treatment(or = 0.28)was needed for ultrasound-guided fluid resuscitation in sepsis patients,95% CI(Confidence interval)= 0.15-0.49,P < 0.0001),length of stay in intensive care unit(SMD =-0.36,95% CI =-0.67-0.05,P = 0.02),amount of resuscitated liquid in 6 hours(SMD =-0.78,95% CI =-1.44-0.12,P =0.02)were better than those in PICCO group,the difference was statistically significant,but for 28 day death rate(or = 0.79,95% CI = 0.53-1.17,P = 0.23),incidence of pulmonary edema(or = 0.45,95% CI = 0.11-1.89,P = 0.28),mechanical ventilation time(SMD =-0.62,95% CI =-1.69-0.46,P = 0.26),6-hour compliance rate(or = 1.53,95% CI = 0.80-2.92,P = 0.19),6-hour central venous pressure(CVP)after resuscitation(SMD = 0.07,95% CI =-0.14-0.29,P = 0.50)and map(SMD =-0.02,95% CI =-0.18-0.14,P = 0.80)after resuscitation had no significant effect.Conclusion:1.Ultrasound guided fluid resuscitation in sepsis shock patients can reduce the number of CRRT treatment needed,shorten the length of stay in ICU and the volume of resuscitated fluid in 6 hours,but it has no significant effect on 28 day mortality,incidence of pulmonary edema,time of mechanical ventilation,6-hour standard rate,CVP and map in 6 hours after resuscitation.2.Ultrasound can protect the kidney and heart tissue better,but it has no significant effect on the long-term mortality and early target-directed therapy.Due to the limited research literature and the lack of gray literature,the above conclusions still need to be verified by a large number of multi center,high-quality research.