Annika Reintam Blaser1, Jan Gunst2, Carole Ichai3, Michael P Casaer4, Carina Benstoem5, Guillaume Besch6, Stéphane Dauger7, Sonja M Fruhwald8, Michael Hiesmayr9, Olivier Joannes-Boyau10, Manu L N G Malbrain11, Maria-Helena Perez12, Stefan J Schaller13, Angelique de Man14, Joel Starkopf15, Kadri Tamme16, Jan Wernerman17, Mette M Berger18. 1. Department of Anaesthesiology and Intensive Care, University of Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. Electronic address: annika.reintam.blaser@ut.ee. 2. Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. Electronic address: jan.gunst@kuleuven.be. 3. Mixed Intensive Care Unit, Université Côte d'Azur, Nice, France. Electronic address: ichai@unice.fr. 4. Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. Electronic address: Michael.casaer@uzleuven.be. 5. Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, Aachen, Germany. Electronic address: cbenstoem@ukaachen.de. 6. Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, Besancon, France. Electronic address: gbesch@chu-besancon.fr. 7. Pediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: stephane.dauger@aphp.fr. 8. Department of Anesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria. Electronic address: sonja.fruhwald@medunigraz.at. 9. Cardiac Thoracic Vascular Anaesthesia and Intensive Care, Medical University Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria. Electronic address: michael.hiesmayr@meduniwien.ac.at. 10. Service d'Anesthésie-Réanimation SUD, Hôpital Magellan, CHU de Bordeaux, Bordeaux, France. Electronic address: olivier.joannes-boyau@chu-bordeaux.fr. 11. Department Intensive Care Medicine, University Hospital Brussel (UZB), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium. Electronic address: Manu.Malbrain@telenet.be. 12. Paediatric Intensive Care Unit, Department of Paediatrics, Division Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: marie-helene.perez@chuv.ch. 13. Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany. Electronic address: stefan.schaller@charite.de. 14. Amsterdam UMC, Location VUMC, Amsterdam, the Netherlands. Electronic address: ame.deman@amsterdamumc.nl. 15. Department of Anaesthesiology and Intensive Care, Tartu University Hospital, University of Tartu, Estonia. Electronic address: Joel.Starkopf@kliinikum.ee. 16. Department of Anaesthesiology and Intensive Care, Tartu University Hospital, University of Tartu, Estonia. Electronic address: Kadri.Tamme@kliinikum.ee. 17. Department of Perioperative Medicine, Karolinska University Hospital Huddinge, CLINTEC Karolinska Institutet, Stockholm, Sweden. Electronic address: jan.wernerman@sll.se. 18. Service of Adult Intensive care & Burns, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: mette.berger@chuv.ch.
Abstract
BACKGROUND & AIMS: Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphatemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphatemia, associated morbidity and treatments. METHODS: A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for pediatric critically ill patients, and prevalence of hypophosphatemia was assessed in both groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. RESULTS: For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphatemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care. In both critically ill adults and children, several studies report that hypophosphatemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphatemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphatemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. CONCLUSIONS: Evidence on the definition, outcome and treatment of clinically relevant hypophosphatemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines.
BACKGROUND & AIMS:Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphatemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphatemia, associated morbidity and treatments. METHODS: A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for pediatric critically illpatients, and prevalence of hypophosphatemia was assessed in both groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. RESULTS: For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphatemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care. In both critically ill adults and children, several studies report that hypophosphatemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphatemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphatemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. CONCLUSIONS: Evidence on the definition, outcome and treatment of clinically relevant hypophosphatemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines.
Authors: Hannah Wozniak; André Dos Santos Rocha; Tal Sarah Beckmann; Christophe Larpin; Niccolò Buetti; Hervé Quintard; Jérôme Pugin; Claudia Paula Heidegger Journal: J Clin Med Date: 2022-01-24 Impact factor: 4.241
Authors: Jean-Charles Preiser; Yaseen M Arabi; Mette M Berger; Michael Casaer; Stephen McClave; Juan C Montejo-González; Sandra Peake; Annika Reintam Blaser; Greet Van den Berghe; Arthur van Zanten; Jan Wernerman; Paul Wischmeyer Journal: Crit Care Date: 2021-12-14 Impact factor: 9.097