6
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be inferred from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients.

          Methods

          Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. Confidence in Network Meta-Analysis (CINeMA) web application was used to rate confidence in synthetic evidence.

          Results

          Fifty-eight trials ( n = 26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR 0.84; 95% CI 0.74–0.95) and L-HES (OR 0.81; 95% CI 0.69–0.95) and reduced acute kidney injury more than L-HES (OR 0.80; 95% CI 0.65–0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR 0.55; 95% CI 0.35–0.87).

          Conclusions

          Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.

          Trial registration

          PROSPERO website, registration number: CRD42018115641).

          Related collections

          Most cited references29

          • Record: found
          • Abstract: not found
          • Article: not found

          Meta-analysis in clinical trials

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial.

            To present some simple graphical and quantitative ways to assist interpretation and improve presentation of results from multiple-treatment meta-analysis (MTM). We reanalyze a published network of trials comparing various antiplatelet interventions regarding the incidence of serious vascular events using Bayesian approaches for random effects MTM, and we explore the advantages and drawbacks of various traditional and new forms of quantitative displays and graphical presentations of results. We present the results under various forms, conventionally based on the mean of the distribution of the effect sizes; based on predictions; based on ranking probabilities; and finally, based on probabilities to be within an acceptable range from a reference. We show how to obtain and present results on ranking of all treatments and how to appraise the overall ranks. Bayesian methodology offers a multitude of ways to present results from MTM models, as it enables a natural and easy estimation of all measures based on probabilities, ranks, or predictions. Copyright © 2011 Elsevier Inc. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.

              In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well." The general definitions introduced as a result of that conference have been widely used in practice and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. Several North American and European intensive care societies agreed to revisit the definitions for sepsis and related conditions. This conference was sponsored by the SCCM, The European Society of Intensive Care Medicine (ESICM), The American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Surgical Infection Society (SIS). The conference was attended by 29 participants from Europe and North America. In advance of the conference, five subgroups were formed to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiologic data, and coagulation parameters. The subgroups corresponded electronically before the conference and met in person during the conference. A spokesperson for each group presented the deliberation of each group to all conference participants during a plenary session. A writing committee was formed at the conference and developed the current article based on executive summary documents generated by each group and the plenary group presentations. The present article serves as the final report of the 2001 International Sepsis Definitions Conference. This document reflects a process whereby a group of experts and opinion leaders revisited the 1992 sepsis guidelines and found that apart from expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience, no evidence exists to support a change to the definitions. This lack of evidence serves to underscore the challenge still present in diagnosing sepsis in 2003 for clinicians and researchers and also provides the basis for introducing PIRO as a hypothesis-generating model for future research.
                Bookmark

                Author and article information

                Contributors
                yukangtu@ntu.edu.tw
                Journal
                Crit Care
                Critical Care
                BioMed Central (London )
                1364-8535
                1466-609X
                14 December 2020
                14 December 2020
                2020
                : 24
                : 693
                Affiliations
                [1 ]GRID grid.19188.39, ISNI 0000 0004 0546 0241, Institute of Epidemiology and Preventive Medicine, , National Taiwan University, ; Room 539, No. 17, Xu-Zhou Rd., Taipei, 10055 Taiwan
                [2 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, , Taipei Medical University, ; Taipei, Taiwan
                [3 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, , Shuang Ho Hospital, Taipei Medical University, ; New Taipei City, Taiwan
                [4 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, , Taipei Medical University, ; New Taipei City, Taiwan
                [5 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, , Taipei Medical University, ; New Taipei City, Taiwan
                [6 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, , Taipei Medical University, ; Taipei, Taiwan
                [7 ]GRID grid.410764.0, ISNI 0000 0004 0573 0731, Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, , Taichung Veterans General Hospital, ; Taichung, Taiwan
                [8 ]GRID grid.265231.1, ISNI 0000 0004 0532 1428, College of Science, , Tunghai University, ; Taichung, Taiwan
                [9 ]GRID grid.19188.39, ISNI 0000 0004 0546 0241, Department of Dentistry, National Taiwan University Hospital, , National Taiwan University, ; Taipei, Taiwan
                [10 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, , Taipei Medical University, ; Taipei, Taiwan
                Author information
                http://orcid.org/0000-0002-2461-474X
                Article
                3419
                10.1186/s13054-020-03419-y
                7734863
                33317590
                189d751e-4f20-4169-b3ea-c0a68d8c0cf6
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 August 2020
                : 30 November 2020
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Emergency medicine & Trauma
                fluid therapy,intensive care,resuscitation,colloids,crystalloids
                Emergency medicine & Trauma
                fluid therapy, intensive care, resuscitation, colloids, crystalloids

                Comments

                Comment on this article