Tine Sylvest Meyhoff1, Morten Hylander Møller2, Peter Buhl Hjortrup2, Maria Cronhjort3, Anders Perner2, Jørn Wetterslev4. 1. Department of Intensive Care, Copenhagen, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark. Electronic address: tine.sylvest.meyhoff@regionh.dk. 2. Department of Intensive Care, Copenhagen, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark. 3. Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Section of Anaesthesia and Intensive Care, Sweden. 4. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark.
Abstract
OBJECTIVE: IV fluids are recommended during the initial management of sepsis, but the quality of evidence is low, and clinical equipoise exists. We aimed to assess patient-important benefits and harms of lower vs higher fluid volumes in adult patients with sepsis. METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials of IV fluid volume separation in adult patients with sepsis. We adhered to our published protocol; the Cochrane handbook; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and the Grading of Recommendations Assessment, Development and Evaluation statements. The primary outcomes were all-cause mortality, serious adverse events (SAEs), and quality of life. RESULTS: We included nine trials (n = 637); all were published after 2015 and had an overall high risk of bias. We found no statistically significant difference between lower vs higher fluid volumes in all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.69-1.10; I2 = 0%; TSA-adjusted CI, 0.34-2.22) or SAEs (RR, 0.91; 95% CI, 0.78-1.05; I2 = 0%; TSA-adjusted CI, 0.68-1.21). No trials reported on quality of life. We did not find differences in the secondary or exploratory outcomes. The quality of evidence was very low across all outcomes. CONCLUSIONS: In this systematic review, we found very low quantity and quality of evidence supporting the decision on the volumes of IV fluid therapy in adults with sepsis. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03668236; URL: www.clinicaltrials.gov.
OBJECTIVE: IV fluids are recommended during the initial management of sepsis, but the quality of evidence is low, and clinical equipoise exists. We aimed to assess patient-important benefits and harms of lower vs higher fluid volumes in adult patients with sepsis. METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials of IV fluid volume separation in adult patients with sepsis. We adhered to our published protocol; the Cochrane handbook; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and the Grading of Recommendations Assessment, Development and Evaluation statements. The primary outcomes were all-cause mortality, serious adverse events (SAEs), and quality of life. RESULTS: We included nine trials (n = 637); all were published after 2015 and had an overall high risk of bias. We found no statistically significant difference between lower vs higher fluid volumes in all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.69-1.10; I2 = 0%; TSA-adjusted CI, 0.34-2.22) or SAEs (RR, 0.91; 95% CI, 0.78-1.05; I2 = 0%; TSA-adjusted CI, 0.68-1.21). No trials reported on quality of life. We did not find differences in the secondary or exploratory outcomes. The quality of evidence was very low across all outcomes. CONCLUSIONS: In this systematic review, we found very low quantity and quality of evidence supporting the decision on the volumes of IV fluid therapy in adults with sepsis. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03668236; URL: www.clinicaltrials.gov.
Authors: Deven Juneja; Raymond D Savio; Shrikanth Srinivasan; Rahul A Pandit; Suresh Ramasubban; Pavan K Reddy; Manoj K Singh; Palepu Bn Gopal; Dhruva Chaudhry; Deepak Govil; Subhal B Dixit; Srinivas Samavedam Journal: Indian J Crit Care Med Date: 2020-11
Authors: Waleed Alhazzani; Morten Hylander Møller; Yaseen M Arabi; Mark Loeb; Michelle Ng Gong; Eddy Fan; Simon Oczkowski; Mitchell M Levy; Lennie Derde; Amy Dzierba; Bin Du; Michael Aboodi; Hannah Wunsch; Maurizio Cecconi; Younsuck Koh; Daniel S Chertow; Kathryn Maitland; Fayez Alshamsi; Emilie Belley-Cote; Massimiliano Greco; Matthew Laundy; Jill S Morgan; Jozef Kesecioglu; Allison McGeer; Leonard Mermel; Manoj J Mammen; Paul E Alexander; Amy Arrington; John E Centofanti; Giuseppe Citerio; Bandar Baw; Ziad A Memish; Naomi Hammond; Frederick G Hayden; Laura Evans; Andrew Rhodes Journal: Intensive Care Med Date: 2020-03-28 Impact factor: 17.440
Authors: Waleed Alhazzani; Morten Hylander Møller; Yaseen M Arabi; Mark Loeb; Michelle Ng Gong; Eddy Fan; Simon Oczkowski; Mitchell M Levy; Lennie Derde; Amy Dzierba; Bin Du; Michael Aboodi; Hannah Wunsch; Maurizio Cecconi; Younsuck Koh; Daniel S Chertow; Kathryn Maitland; Fayez Alshamsi; Emilie Belley-Cote; Massimiliano Greco; Matthew Laundy; Jill S Morgan; Jozef Kesecioglu; Allison McGeer; Leonard Mermel; Manoj J Mammen; Paul E Alexander; Amy Arrington; John E Centofanti; Giuseppe Citerio; Bandar Baw; Ziad A Memish; Naomi Hammond; Frederick G Hayden; Laura Evans; Andrew Rhodes Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598