Journal Club 血管拡張性ショックに対する 血圧管理 …

1 JournalClub 2018/03/13 2 Intensive Care Med (2018) 44:12 21 3 4 PhlugersArch 1987;410-449 RBF (MAP) MAP 65mmHg 5 Surviving sepsis campaign: international guidelines for managementof severe sepsis and septic shock: 2012. CritCare Med 41:580 637 Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795 1815 Intensive Care Med 42 65mmHg RCT SEPSISPAM trial OVATION trial 7N EnglJ Med 2014; 370:1583-1593 Intensive Care Med (2016) 42:542 550 SEPSISPAM trial8N EnglJ Med 2014; 370:1583-1593 SEPSISPAM trialP 776 IHigh-TargetGroup(MAP80 85mmHg)CLow-Target Group (MAP65 70mmHg)O28 9 Primary outcome28 Secondary outcome90 Low-Targetgroup Adverse eventsHigh-TargetGroup 10 OVATION trial 11 Intensive Care Med (2016) 42:542 550 OVATION trialP 118 70% IHigh-TargetGroup(MAP:75 80mmHg)CLow-Target Group (MAP:60-65mmHg)O MAP pilot trial 12 Primary outcome MAP 9mmHgClinical outcomeICU 28 6 Adverseeffects 131475 LowTargetGroup RCT 15 16 Intensive Care Med (2018) 44.

2 12 21 CLINICAL QUESTIONS 28 28 Systematicreview meta-analysis 17 18 PICO RCT P Higher MAP target CLower MAP target O28 19 MEDLINE(1946 2017 1 )EMBASE(1980 2017 1 )Cochrane Central Register of Controlled Trials 24 20 PROSPERO (CRD42016037482) RCT 21 PrimaryOutcome28 Secondary Outcome 90 ( ) 5 MAP 22 23 Risk of biasCochrane Collaboration s instrument riskofbias 24 28 ( ) Fisher extract test 28 Kaplan-Meier 3 25 1.

3 2. 3. 4. 6 vs 26 40 80 3 5 10 20 27 Study 5 28 5 MAP 28 95 < SAS 308343 57 2 RCT SEPSISPAM trial(n=776)&OVATION trial(n=118)312 RCT SEPSISPAM(n=776)OVATION(n=118)P valueAge sex517 (67%)64 (54%) II score 10 all domains OVATION 8% vs1% Baseline characteristicsHighertargetvsLowertarget 33 Baseline characteristicsHighertargetvsLowertarget 34 Risk of bias2 RCT Overall risk of bias 35 36 OVATION studyHigher target target studyHigher target target 90 Higher TargetLower TargetOR (95% CI)p-value28-day mortalitySEPSISPAM142/388 (37%)132/388 (34%) ( ) (33%)16/60 (27%) ( ) (36%)148/448 (33%) ( ) mortalitySEPSISPAM170/388 (44%)164/388 (42%) ( ) (40%)20/60 (33%) ( ) (43%)184/448 (41%) ( )

4 Figure 2 6 Higher target 3828 3990 Higher target 4028 41 6 Higher target 28 28 42 6 Higher target 28 43 44 28 6 45 Higher Target, >6h Lower Target,>6h 46 Higher Target, 6h Lower Target, 6h 47 MAP 48 6 49 SEPSISPAM 50