Systematic Reviews最新文献

{"title":"Effectiveness and user experience of ambient artificial intelligence-driven scribe technology among clinicians: a protocol for a systematic review.","authors":"Ravi Shankar, Fiona Devi Siva Kumar, Anjali Bundele, Amartya Mukhopadhyay","doi":"10.1186/s13643-026-03220-y","DOIUrl":"10.1186/s13643-026-03220-y","url":null,"abstract":"<p><strong>Background: </strong>The increasing adoption of electronic health records (EHRs) has contributed to high documentation burden among clinicians, negatively impacting job satisfaction and contributing to burnout. Ambient AI-driven scribe technology has emerged as a potential solution to automate clinical documentation and reduce clerical burden. However, the effectiveness and user experience of AI-scribes for clinicians have not been comprehensively evaluated. This systematic review will critically evaluate the current scientific evidence on the effectiveness and user experience of AI-driven scribe technology from the perspective of clinicians.</p><p><strong>Methods: </strong>We will conduct a systematic search of PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus from database inception to December 2024. The search strategy will include terms related to AI-scribes, clinical documentation, and clinician experience. We will include randomized trials, observational studies, qualitative studies, and usability evaluations of AI-driven scribe technology used by clinicians in outpatient settings. Two reviewers will independently screen studies, extract data, and assess risk of bias using standardized tools. Results will be synthesized narratively and quantitatively where appropriate, with a focus on identifying key benefits, challenges, and future directions to optimize AI-scribes for enhanced clinician experience and patient care delivery.</p><p><strong>Discussion: </strong>By providing a comprehensive evidence synthesis, this systematic review will inform strategic decision-making around the adoption and implementation of AI-driven scribes in clinical practice. The results will identify areas for future research and development of this promising technology to best support clinicians and alleviate documentation burden. Findings may also guide policies and best practices.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024600076.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"15 1","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fever on hospital admission is associated with increased disease severity and mortality in acute pancreatitis: a systematic review and meta-analysis.","authors":"Eszter Pakai, Krisztian Klonfar, Anna Walter, Nelli Farkas, Anna Sara Bognar, Jimin Lee, Peter Hegyi, Andras Garami","doi":"10.1186/s13643-026-03265-z","DOIUrl":"10.1186/s13643-026-03265-z","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) is often accompanied by changes in body temperature (T_b), but whether and how T_b at hospital admission is associated with the outcome of the disease remained unclear. Previous studies showed contradictory results regarding its prognostic value, and no meta-analysis was performed.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched the PubMed, Embase, and CENTRAL databases (from inception to April 25, 2024) for studies in adult AP patients with reported admission T_b and mortality rate or a disease severity marker. With a random-effects model, we calculated pooled proportion (for mortality) or pooled mean (for secondary outcomes) with 95% CI and compared them between febrile and afebrile subgroups. With meta-regression, we assessed the correlation between admission T_b and mortality or length of hospital stay (LOS).</p><p><strong>Results: </strong>We found 26 eligible studies including data from 40,630 AP patients. The pooled mortality rate was higher (p < 0.001) in febrile patients (0.15, 95% CI 0.11-0.20; I² = 40%) than in afebrile patients (0.05, 95% CI 0.03-0.09; I² = 98%). LOS was longer (p = 0.025) in the febrile subgroup (39.1 days, 95% CI 16.8-61.4; I² = 91%) than in the afebrile subgroup (17.5 days, 95% CI 7.6-27.5; I² = 96%). With meta-regression, admission T_b significantly and positively correlated with mortality (0.09, 95% CI 0.07-0.12) and LOS (16.5, 95% CI 5.6-27.5). The APACHE II score was significantly (p = 0.030) higher, while the SOFA score tended to be higher (p = 0.168) in the febrile than in the afebrile subgroup. Blood levels of amylase and C-reactive protein did not differ meaningfully between the groups.</p><p><strong>Conclusions: </strong>Fever on admission is associated with higher mortality, increased disease severity, and longer hospitalization in AP. High-quality studies with standardized T_b measurements are needed to determine the prognostic performance of admission T_b in AP.</p><p><strong>Systematic review registration: </strong>This study was registered with PROSPERO on 16 January 2020 (registration number: CRD42020139154).</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current evidence does not demonstrate decreased ICU length of stay and delirium incidence associated with the use of volatile sedation in critically ill patients: re-analysis of data from a recent systematic review.","authors":"Jiawen Deng","doi":"10.1186/s13643-026-03271-1","DOIUrl":"10.1186/s13643-026-03271-1","url":null,"abstract":"","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"15 1","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invisible but central: family caregiving as the hidden infrastructure of pediatric PKU-an integrative review.","authors":"Daria Słomińska, Łukasz Kałużny, Dariusz Walkowiak","doi":"10.1186/s13643-026-03267-x","DOIUrl":"10.1186/s13643-026-03267-x","url":null,"abstract":"<p><strong>Background: </strong>Phenylketonuria (PKU) is a rare metabolic disorder requiring lifelong dietary management. While clinical stability hinges on strict treatment adherence, this adherence is largely sustained by unpaid family caregiving, particularly in pediatric contexts. Yet, the lived experience of caregivers remains conceptually underexamined and largely absent from PKU research. This integrative review synthesizes empirical findings on caregiver burden in pediatric PKU and maps a multilevel burden structure that traces its structural, relational, and psychological dimensions.</p><p><strong>Methods: </strong>Using Whittemore and Knafl's integrative methodology, 31 empirical studies-20 quantitative, 7 qualitative, and 4 mixed-methods-published between 2010 and 2025 were included. Studies were included if they reported on caregivers of pediatric PKU patients; studies focusing on adult patients or without caregiver data were excluded. Thematic coding and axial analysis were applied to identify macro (structural), meso (relational), and micro (psychological) patterns. Methodological triangulation enhanced both analytical rigor and conceptual depth. Studies were identified via a structured PubMed search (updated April 2025) and manual reference screening.</p><p><strong>Results: </strong>The review included 31 empirical studies encompassing over 3000 caregivers across 12 countries. At the macro level, key themes included policy fragmentation, the feminization of caregiving roles, and financial precarity. Meso-level patterns revealed persistent emotional asymmetry, compounded relational overload, and hierarchical caregiving dynamics within family systems. At the micro level, caregivers reported chronic emotional depletion, elements of moral injury, and progressive role engulfment. Collectively, these findings outline a relational ecology of care in which emotional and physical caregiving labor operates as a compensatory mechanism for structural and institutional neglect.</p><p><strong>Conclusion: </strong>Family caregivers in pediatric PKU are not peripheral supporters but central contributors to clinical stability. Yet their role remains structurally unsupported and emotionally overburdened. Their psychosocial burden has direct clinical consequences for both the caregivers' health and the children's treatment outcomes. Sustainable PKU care-and by extension, care for other rare and chronic pediatric conditions-requires systemic investment in caregiving infrastructure, not as an act of goodwill, but as a clinical imperative. Findings should be interpreted in light of contextual heterogeneity and limited representation from low-income settings.</p><p><strong>Systematic review registration: </strong>Not registered.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural determinants and health-related quality of life among people living with HIV: a systematic review and meta-analysis protocol.","authors":"Jason M Lo Hog Tian, Branden Ngo, Divya Parmar, Aditi Chiney, Lori Rosman, Kaitlyn Atkins, Amrita Rao, Stefan Baral","doi":"10.1186/s13643-026-03264-0","DOIUrl":"10.1186/s13643-026-03264-0","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy has increased life expectancy of people living with HIV, though estimates of quality of life remain consistently lower than that of the general population. Research on determinants of health-related quality of life among people living with HIV has predominantly focused on clinical factors, with limited attention to upstream structural determinants, or the economic, political, and social systems shaping resource distribution and health outcomes. Moreover, structural and social determinants are frequently conflated in the literature, challenging both conceptual clarity and intervention design. A comprehensive synthesis leveraging a conceptual framework can support improved characterization of which structural factors are most strongly associated with health-related quality of life, distinguish structural from social determinants, and inform policy and programmatic priorities for improving the health and wellbeing for people living with HIV.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, CINAHL, PsycINFO, PAIS, Sociological Abstracts, and Scopus from database inception to February 2026. Eligible studies will quantitatively examine associations between structural determinants (including policy and legal environment, culture, social class, socioeconomic position, stigma and discrimination, built environment, and material living conditions) and health-related quality of life measured using validated instruments among people living with HIV. Two reviewers will independently screen studies, extract data, and assess risk of bias using Joanna Briggs Institute critical appraisal tools. Random-effects meta-analysis will pool effect estimates where sufficient homogeneity exists. Subgroup analyses will examine variation by geographic region, gender, race, and structural determinant category.</p><p><strong>Discussion: </strong>This review will systematically synthesize evidence on structural determinants of health-related quality of life among people living with HIV. Findings will identify modifiable upstream factors associated with quality of life, informing prioritization of structural interventions alongside biomedical approaches to HIV care. The review will also map evidence gaps, highlighting under-explored structural determinants and populations to guide research. By contributing to conceptual clarity in a field where structural and social determinants are frequently conflated, this review will provide a framework for more precise measurement and intervention design in future studies.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420261373190.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, immunogenicity, efficacy, and effectiveness of mpox vaccines in pregnant persons, children, and adolescents: a protocol for a living systematic review and meta-analysis.","authors":"Jamile Ballivian, Agustín Ciapponi, Mabel Berrueta, Juan Manuel Sambade, Ariel Bardach, Martin Brizuela, Julieta Caravario, Noelia Castellana, Esteban Couto, Daniel Comandé, Agustina Mazzoni, Vanesa Ortega, Florencia Salva, Katharina Stegelmann, Juan Pablo Smutny, Edward P K Parker, Andy Stergachis, Xu Xiong, Flor M Munoz, Pierre M Buekens","doi":"10.1186/s13643-026-03254-2","DOIUrl":"10.1186/s13643-026-03254-2","url":null,"abstract":"<p><strong>Background: </strong>Mpox is a zoonotic disease caused by the monkeypox virus (MPXV) that became a global health concern following the 2022 outbreak. It poses a significant threat to immunocompromised individuals, children, and pregnant persons. Disease spread in the Democratic Republic of the Congo (DRC) and propagation to other countries has led to recent declarations of public health emergencies. Smallpox vaccination cessation has further heightened population vulnerability to MPXV. In response, MVA-BN and LC16m8, vaccinia-based vaccines originally developed for smallpox, have been repurposed for mpox, demonstrating promising safety and immunogenicity profiles. Despite these advancements, challenges remain in vaccine distribution and in understanding vaccine efficacy across populations, particularly in key at-risk groups. Available evidence remains fragmented and largely derived from adult populations, with limited data in pregnant persons, children, and adolescents. This living systematic review (LSR) aims to evaluate the safety, efficacy, effectiveness, and immunogenicity of mpox vaccines across populations, with particular focus on pregnant persons, children, and adolescents.</p><p><strong>Methods: </strong>We aim to conduct a LSR and meta-analysis based on biweekly searches of medical databases and clinical trial registries from inception to the current date to systematically identify relevant studies of mpox vaccines across populations. Pairs of reviewers will independently select eligible studies, extract data, and assess the risk of bias. We will include randomized clinical trials, quasi-experimental studies, cohort studies, case-control studies, cross-sectional studies, and case reports. Primary outcomes will include safety, efficacy/effectiveness, and immunogenicity of mpox vaccines across populations, including outcomes in pregnant persons (with neonatal outcomes), children, and adolescents. Meta-analyses will be conducted, including prespecified subgroup and sensitivity analyses. We will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence.</p><p><strong>Discussion: </strong>This LSR will synthesize evidence on mpox vaccines across populations, with particular focus on pregnant persons, children, and adolescents. As mpox continues to pose a global threat, particularly in endemic and low-resource settings, timely and rigorous assessment of vaccine performance is essential to guide equitable immunization policies and maternal-child health strategies.</p><p><strong>Systematic review registration: </strong>International Prospective Register of Systematic Reviews (PROSPERO): CRD42024554330 (pregnant persons) and CRD42024556977 (children and adolescents).</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the role of qualitative evidence synthesis in health and social care guideline development: perspectives from guideline committee members and technical staff in a leading UK producer of health and social care guidelines.","authors":"Chris Carmona, Christopher Carroll, Susan Baxter","doi":"10.1186/s13643-026-03268-w","DOIUrl":"10.1186/s13643-026-03268-w","url":null,"abstract":"<p><p>This paper explores the perceptions and experiences of guideline committee members and technical staff at the UK's National Institute for Health and Care Excellence (NICE) regarding the use of qualitative evidence syntheses (QES) in the guideline development process. While QES has the potential to enrich guideline development with insights into service user experiences, implementation contexts, and social determinants of health, its integration into the process remains inconsistent. Drawing on 12 semi-structured interviews conducted with members from clinical, public health, and social care committees, and NICE technical staff, this qualitative study aimed to identify factors influencing the committees' use of QES in making guideline recommendations. Detailed analysis of the data identified three recurring themes: (1) trust in the credibility and robustness of QES; (2) challenges in the presentation and comprehension of QES; and (3) perceived value and limitations of QES in decision-making. Participants described uncertainty about qualitative methodologies, a reliance on the quantitative hierarchy of evidence, and variability in the quality and clarity of QES reporting. Despite these concerns, many saw QES as vital in amplifying service user voices and supporting lay-member engagement. The findings underscore the need for improved methodological transparency, clearer integration of qualitative and quantitative evidence, and capacity building in QES methods. This study contributes to the literature on evidence-informed policy and practice, highlighting key challenges and offering practical recommendations for enhancing the role of QES in guideline development.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health screening in women with polycystic ovary syndrome: protocol for a systematic review and meta-analysis.","authors":"Rajalakshmi Rajendran, Marva Abdul Khader, Priya Shivanna, Prathiksha M Shet, Niyam Hegde, Deeya Karkera, Girish Thunga","doi":"10.1186/s13643-026-03269-9","DOIUrl":"10.1186/s13643-026-03269-9","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age and is reported frequently with mental health disorders. This systematic review aims to synthesize the available evidence on mental health screening and its potential role in identifying and addressing mental health conditions among women with PCOS.</p><p><strong>Methods: </strong>This systematic review will be conducted according to JBI methodology for systematic reviews of effectiveness. The search strategy will follow the Peer Review of Electronic Search Strategies (PRESS) checklist. Literature searches will be conducted in the Cochrane Library, PubMed/MEDLINE, Scopus, Embase, CINAHL, Web of Science, and PsycINFO databases, as well as relevant grey literature sources. Studies involving women with PCOS that report the use of mental health screening tools or assessment of mental health outcomes will be eligible for inclusion. Experimental, quasi-experimental, and observational studies will be considered. Two independent reviewers will perform study selection and data extraction using predefined eligibility criteria and standardized forms, with disagreements resolved through discussion or consultation with a third reviewer. Methodological quality will be assessed using the JBI critical appraisal tools appropriate to the study design. Where sufficient data are available, a meta-analysis will be conducted; otherwise, findings will be synthesized narratively. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Discussion: </strong>This systematic review will provide a comprehensive synthesis of the available evidence on mental health screening among women with PCOS. The findings may inform clinical practice, support evidence-based guideline development, and identify priorities for future research in the holistic management of PCOS.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420251240567.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic scoping review on quality criteria for clinical practice guidelines for rare diseases.","authors":"Iméze J Hieltjes, Mirthe J Klein Haneveld, Ingeborg Van Dusseldorp, Charlotte M W Gaasterland, Johanna H van der Lee","doi":"10.1186/s13643-026-03247-1","DOIUrl":"10.1186/s13643-026-03247-1","url":null,"abstract":"<p><strong>Background: </strong>Rare diseases impose substantial challenges on affected individuals and healthcare systems. While clinical practice guidelines (CPGs) are crucial for standardizing care, tools to assess their trustworthiness are limited, particularly for rare diseases. There is a need for minimum quality criteria to ensure CPG reliability and utility.</p><p><strong>Objective: </strong>This systematic scoping review aims to identify a set of criteria that can be used for evaluating and endorsing CPGs for rare diseases.</p><p><strong>Methods: </strong>A systematic scoping review was conducted using four databases (Ovid/Medline, Embase.com, Scopus, and Google Scholar) from inception to April 9, 2024. The search was developed by a medical information specialist. Titles and abstracts were independently screened by two reviewers, with disagreements resolved through discussion or a third reviewer. Articles were included if they addressed quality criteria for guidelines on rare diseases in general, excluding disease-specific guidelines.</p><p><strong>Results: </strong>From 9587 unique titles, only one study met the inclusion criteria. The included study, published by Hilton-Boon et al. (2015), summarized an international workshop on the applicability of AGREE II criteria for rare disease guidelines.</p><p><strong>Conclusion: </strong>Our systematic review identified a single report detailing an international workshop that evaluated the utility of the AGREE II instrument for assessing two guidelines focused on rare diseases. This limited finding highlights a significant gap in methodologies tailored to the specific complexities of rare disease guidelines. The findings underscore the need for a tailored, streamlined set of criteria to address the unique challenges of rare disease guidelines, supporting their development, evaluation, and endorsement in clinical practice.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the efficacy of esmolol in septic shock: a systematic review and meta-analysis.","authors":"Retaj Al-Nafai, Ghaid Aljahdali, Lama Alrebish, Maisa Albeladi, Haneen Alharbi, Rawiah Maghrabi, Hind Alotaibi, Lama Algathama, Asma Abbas, Rawan Albariqi, Maram Alshahrani, Abdulmajeed M Alshehri, Lama Alfehaid","doi":"10.1186/s13643-026-03260-4","DOIUrl":"10.1186/s13643-026-03260-4","url":null,"abstract":"<p><strong>Background: </strong>Persistent tachycardia in septic shock is associated with adverse outcomes, yet optimal management remains uncertain. Esmolol, a short-acting β1-selective blocker, has been investigated as a strategy to control heart rate and attenuate excessive sympathetic activation. This systematic review and meta-analysis evaluated the efficacy of esmolol in adult patients with septic shock.</p><p><strong>Methods: </strong>A comprehensive search of PubMed/MEDLINE, Cochrane Central, and Google Scholar was conducted from database inception to March 28, 2025. Reference lists and clinical trial registries were also screened. Randomized controlled trials comparing esmolol plus standard care with standard care alone in adults with septic shock were included. The primary outcome was 28-day mortality. Secondary outcomes included heart rate, mean arterial pressure (MAP), and lactate.</p><p><strong>Results: </strong>Three randomized controlled trials involving 314 patients were included. Esmolol was associated with a significant reduction in 28-day mortality (OR 0.33, 95% CI 0.20-0.53; I2 = 0%). Heart rate was significantly reduced at both 24 h (day 1) (MD - 8.50 bpm, 95% CI - 10.82 to - 6.17) and 48 h (day 2) (MD - 16.60 bpm, 95% CI - 20.03 to - 13.17). No statistically significant difference in MAP was observed between groups (MD 0.10 mmHg, 95% CI - 3.46 to 3.66; I2 = 53%). Although the included studies did not report clinically meaningful differences in lactate levels, differences in outcome reporting precluded quantitative synthesis.</p><p><strong>Conclusions: </strong>Esmolol therapy may improve heart rate control and reduce 28-day mortality in carefully selected patients with septic shock without adversely affecting MAP. However, these findings should be interpreted cautiously because they are based on a limited number of randomized trials and are subject to clinical heterogeneity and potential risk of bias. Larger, high-quality randomized controlled trials are needed to confirm these findings and define the optimal use of esmolol in septic shock.</p><p><strong>Systematic review registration: </strong>The review protocol was registered with PROSPERO (CRD42024584599).</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}