Comparative efficacy of hemodynamic resuscitation strategies in severe sepsis: a systematic review of impact on mortality and complications in critically ill patients
DOI:
https://doi.org/10.56183/iberojhr.v4i2.668Palavras-chave:
Severe sepsis, hemodynamic resuscitation, fluid resuscitation, vasopressors, early goal-directed therapy (EGDT), mortality.Resumo
Introduction: Severe sepsis and septic shock present significant challenges in critical care, requiring effective hemodynamic resuscitation strategies to improve patient outcomes. This review aims to assess the comparative efficacy of hemodynamic resuscitation strategies—including fluid resuscitation, vasopressors, and advanced therapeutic interventions—on mortality, ICU stay, and complications in patients with severe sepsis and septic shock. Methods: A systematic literature search was conducted across PubMed, Embase, and Cochrane Library for studies published between 2019 and 2024. Eligible studies focused on the effects of different hemodynamic strategies in severe sepsis patients. A total of 3138 articles were identified, and after screening, 14 studies met the inclusion criteria. The quality of included studies was evaluated using the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. Results: Fourteen studies were included, encompassing various strategies such as EGDT, vasopressor use, and fluid resuscitation. Notably, EGDT did not show significant mortality reduction compared to protocolized resuscitation care, with vasopressor demand 20% lower in the EGDT group. Balanced crystalloids significantly reduced 30-day mortality compared to saline. Early norepinephrine improved shock control rates and reduced mortality compared to standard care. Fluid resuscitation strategies showed mixed outcomes; while higher fluid resuscitation rates were linked to faster shock reversal and lower 28-day mortality, medium-volume fluid resuscitation (20-30 mL/kg) was most effective in reducing 28-day mortality. Prehospital hemodynamic optimization also demonstrated a significant reduction in 30-day mortality. Conclusion: Hemodynamic strategies such as balanced crystalloids and early norepinephrine may improve outcomes in severe sepsis and septic shock, although further studies are needed to determine optimal treatment protocols.
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Copyright (c) 2024 John Manuel Dorado Ramírez, Yuliana Arely Medina Alvarado, Luis Enrique Salgado Gordillo, César Leonardo Granda Quezada, Natalia Quintero Serrano, Valeria Alexandra Vásconez Montalvo, Jonathan Santiago Granda Granda
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