BACKGROUND: Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear. PURPOSE: To examine the effect of different resuscitative fluids on mortality in patients with sepsis. DATA SOURCES: MEDLINE, EMBASE, ACP Journal Club, CINAHL, HealthSTAR, the Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials through March 2014. STUDY SELECTION: Randomized trials that evaluated different resuscitative fluids in adult patients with sepsis or septic shock and death. No language restrictions were applied. DATA EXTRACTION: Two reviewers extracted data on study characteristics, methods, and outcomes. Risk of bias for individual studies and quality of evidence were assessed. DATA SYNTHESIS: 14 studies (18916 patients) were included with 15 direct comparisons. Network meta-analysis at the 4-node level showed higher mortality with starches than with crystalloids (high confidence) and lower mortality with albumin than with crystalloids (moderate confidence) or starches (moderate confidence). Network meta-analysis at the 6-node level showed lower mortality with albumin than with saline (moderate confidence) and low-molecular-weight starch (low confidence) and with balanced crystalloids than with saline (low confidence) and low- and high-molecular-weight starches (moderate confidence). LIMITATIONS: These trials were heterogeneous in case mix, fluids evaluated, duration of fluid exposure, and risk of bias. Imprecise estimates for several comparisons in this network meta-analysis contribute to low confidence in most estimates of effect. CONCLUSION: Among patients with sepsis, resuscitation with balanced crystalloids or albumin compared with other fluids seems to be associated with reduced mortality. PRIMARY FUNDING SOURCE: The Hamilton Chapter of the Canadian Intensive Care Foundation and the Critical Care Medicine Residency Program and Critical Care Division Alternate Funding Plan at McMaster University.
BACKGROUND: Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear. PURPOSE: To examine the effect of different resuscitative fluids on mortality in patients with sepsis. DATA SOURCES: MEDLINE, EMBASE, ACP Journal Club, CINAHL, HealthSTAR, the Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials through March 2014. STUDY SELECTION: Randomized trials that evaluated different resuscitative fluids in adult patients with sepsis or septic shock and death. No language restrictions were applied. DATA EXTRACTION: Two reviewers extracted data on study characteristics, methods, and outcomes. Risk of bias for individual studies and quality of evidence were assessed. DATA SYNTHESIS: 14 studies (18916 patients) were included with 15 direct comparisons. Network meta-analysis at the 4-node level showed higher mortality with starches than with crystalloids (high confidence) and lower mortality with albumin than with crystalloids (moderate confidence) or starches (moderate confidence). Network meta-analysis at the 6-node level showed lower mortality with albumin than with saline (moderate confidence) and low-molecular-weight starch (low confidence) and with balanced crystalloids than with saline (low confidence) and low- and high-molecular-weight starches (moderate confidence). LIMITATIONS: These trials were heterogeneous in case mix, fluids evaluated, duration of fluid exposure, and risk of bias. Imprecise estimates for several comparisons in this network meta-analysis contribute to low confidence in most estimates of effect. CONCLUSION: Among patients with sepsis, resuscitation with balanced crystalloids or albumin compared with other fluids seems to be associated with reduced mortality. PRIMARY FUNDING SOURCE: The Hamilton Chapter of the Canadian Intensive Care Foundation and the Critical Care Medicine Residency Program and Critical Care Division Alternate Funding Plan at McMaster University.
Authors: Ramin Bighamian; Bahram Parvinian; Christopher G Scully; George Kramer; Jin-Oh Hahn Journal: Control Eng Pract Date: 2018-03-14 Impact factor: 3.475
Authors: B Rochwerg; W Alhazzani; A Gibson; C M Ribic; A Sindi; D Heels-Ansdell; L Thabane; A Fox-Robichaud; L Mbuagbaw; W Szczeklik; F Alshamsi; S Altayyar; W Ip; G Li; M Wang; A Włudarczyk; Q Zhou; D Annane; D J Cook; R Jaeschke; G H Guyatt Journal: Intensive Care Med Date: 2015-04-23 Impact factor: 17.440
Authors: Cristina Gutierrez; Anne Rain T Brown; Megan M Herr; Sameer S Kadri; Brian Hill; Prabalini Rajendram; Abhijit Duggal; Cameron J Turtle; Kevin Patel; Yi Lin; Heather P May; Alice Gallo de Moraes; Marcela V Maus; Mathew J Frigault; Jennifer N Brudno; Janhavi Athale; Nirali N Shah; James N Kochenderfer; Ananda Dharshan; Amer Beitinjaneh; Alejandro S Arias; Colleen McEvoy; Elena Mead; R Scott Stephens; Joseph L Nates; Sattva S Neelapu; Stephen M Pastores Journal: J Crit Care Date: 2020-04-15 Impact factor: 3.425
Authors: Scott L Weiss; Luke Keele; Fran Balamuth; Neika Vendetti; Rachael Ross; Julie C Fitzgerald; Jeffrey S Gerber Journal: J Pediatr Date: 2017-01-04 Impact factor: 4.406