Ask an answerable question (PICO)：
Clinical medical staff often rely on vital signs, urine output and CVP values to judge and give rapid fluid resuscitation treatment to patients with septic shock, which can easily cause fluid overload and lead to tissue hypoxia, organ failure and even death. To avoid excessive and insufficient fluid resuscitation, for adults with septic shock, using equipment that can assess dynamic parameters, assessing fluid responsiveness and giving fluid resuscitation or vasopressor treatment according to the results, can avoid ineffective fluid treatment leading to fluid overload causing organ burden and avoid improper use of vasopressors aggravating organ tissue perfusion insufficiency. Passive leg raising is one of the dynamic ways to measure fluid responsiveness, with good sensitivity and specificity (85% and 91%, respectively), and can be used for hemodynamic management of septic shock (Monnet et al., 2022).
Therefore, the question is raised: “Does passive leg raising test used for fluid resuscitation guidance in patients with septic shock reduce hospital mortality?” It is hoped that by exploring the evidence-based literature, it will provide clinical care reference.
The Method and Analysis of Literature Review：
According to the first three steps of the evidence-based five A’s (asking, acquire, appraisal), the PICO question is formed: “Does passive leg raising test used for fluid resuscitation guidance in patients with septic shock reduce hospital mortality?” Using MeSH term, natural language, synonyms to set up Chinese and English keywords, using Boolean logic, truncation word retrieval skills to search CEPS Airiti Chinese Journal, Taiwan Journal Article Index System, Taiwan Master’s Thesis System, Cochrane Library, PubMed, CINAHL, Embase, Nursing Reference Center eight Chinese and English databases and google scholar search, and using the “Limit” retrieval function, limiting the inclusion criteria for literature as: (1) SR or RCT literature (2) regardless of language and ethnic group human, a total of 506 literature were searched, manually reviewed to delete duplicate literature, research population, intervention measures, research design does not match, finally a total of 2 randomized controlled trial literature, 1 systematic review literature, a total of 3 literature meet the inclusion criteria for review and analysis.
Critical Appraisal：
The 3 literature reviews included in this article are based on the CASP assessment form literature review tool. According to the research evidence level classification of the Oxford Centre for Evidence Based Medicine (2011), the evidence level of the 3 literature reviews in this article are all Level 1, and the recommendation level of the synthesis results is A.
Results, Conclusions and Recommendations：
For the clinical scenario question in this article, explain to the family that performing a passive leg raise test before giving fluid infusion and using a cardiac output monitor can predict whether fluid infusion will increase cardiac output and then decide whether to give fluid infusion or vasopressor treatment, which can avoid excessive fluid infusion treatment causing organ damage and avoid improper use of vasopressors that aggravate organ tissue perfusion insufficiency and improve patient safety.
