RESUMO
Purpose: Antibiotic-resistant bacterial pneumonia poses a significant therapeutic challenge. In China, Chinese herbal compound (CHC) is commonly used to treat bacterial pneumonia. We aimed to evaluate the efficacy and safety of CHC and identify core herb combinations for the treatment of multidrug-resistant or extensively drug-resistant bacterial pneumonia. Methods: Stata 16 and TSA 0.9.5.10 beta software were used for meta-analysis and trial sequential analysis (TSA), respectively. Exploring the sources of heterogeneity through meta-regression and subgroup analysis. Results: Thirty-eight studies involving 2890 patients were included in the analyses. Meta-analysis indicated that CHC combined with antibiotics improved the response rate (RR = 1.24; 95% CI: 1.19-1.28; p < 0.0001) and microbiological eradication (RR = 1.41; 95% CI: 1.27-1.57; p < 0.0001), lowered the white blood cell count (MD = -2.09; 95% CI: -2.65 to -1.53; p < 0.0001), procalcitonin levels (MD = -0.49; 95% CI: -0.59 to -0.40; p < 0.0001), C-reactive protein levels (MD = -11.80; 95% CI: -15.22 to -8.39; p < 0.0001), Clinical Pulmonary Infection Scores (CPIS) (MD = -1.97; 95% CI: -2.68 to -1.26; p < 0.0001), and Acute Physiology and Chronic Health Evaluation (APACHE)-II score (MD = -4.08; 95% CI: -5.16 to -3.00; p < 0.0001), shortened the length of hospitalization (MD = -4.79; 95% CI: -6.18 to -3.40; p < 0.0001), and reduced the number of adverse events. TSA indicated that the response rate and microbiological eradication results were robust. Moreover, Scutellaria baicalensis Georgi, Fritillaria thunbergii Miq, Lonicera japonica Thunb, and Glycyrrhiza uralensis Fisch were identified as core CHC prescription herbs. Conclusion: Compared with antibiotic treatment, CHC + antibiotic treatment was superior in improving response rate, microbiological eradication, inflammatory response, CPIS, and APACHE-II score and shortening the length of hospitalization. Association rule analysis identified four core herbs as promising candidates for treating antibiotic-resistant bacterial pneumonia. However, large-scale clinical studies are still required. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023410587.
RESUMO
OBJECTIVE: To investigate the clinical values of blood pressure, heart rate and central venous pressure before and after fluid challenge to predict volume responsiveness. METHODS: A total of 86 fluid challenges in 39 patients with hemodynamic monitoring were retrospectively analyzed. Fluid challenges were separated into responder group and control group based on whether a 10% increase in cardiac output was achieved by fluid challenge. Such physiologic variables as systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP) were recorded before and after fluid challenges. RESULTS: ΔSBP, ΔDBP, ΔPP and ΔMAP before and after fluid challenge were significantly higher in responder group than control group. Logistic regression analysis identified ΔPP as the only independent predictor of fluid responsiveness (OR 1.100, 95%CI 1.037 - 1.167). Fluid responsiveness was predicted by ΔPP ≥ 5 mm Hg with sensitivity 78.4%, specificity 75.7%, positive predict value 76.3% and negative predict value 77.8%. Only ΔPP correlated with ΔCO by Pearson correlation analysis (r = 0.417, P < 0.001). CONCLUSION: ΔPP before and after fluid challenge can predict volume responsiveness while HR and CVP can not.
