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Fluid resuscitation in sepsis: a systematic review and network meta-analysis.
Ann Intern Med 2014; 161(5):347-55AIM

Abstract

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

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

25047428

Citation

Rochwerg, Bram, et al. "Fluid Resuscitation in Sepsis: a Systematic Review and Network Meta-analysis." Annals of Internal Medicine, vol. 161, no. 5, 2014, pp. 347-55.
Rochwerg B, Alhazzani W, Sindi A, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med. 2014;161(5):347-55.
Rochwerg, B., Alhazzani, W., Sindi, A., Heels-Ansdell, D., Thabane, L., Fox-Robichaud, A., ... Annane, D. (2014). Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Annals of Internal Medicine, 161(5), pp. 347-55. doi:10.7326/M14-0178.
Rochwerg B, et al. Fluid Resuscitation in Sepsis: a Systematic Review and Network Meta-analysis. Ann Intern Med. 2014 Sep 2;161(5):347-55. PubMed PMID: 25047428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluid resuscitation in sepsis: a systematic review and network meta-analysis. AU - Rochwerg,Bram, AU - Alhazzani,Waleed, AU - Sindi,Anees, AU - Heels-Ansdell,Diane, AU - Thabane,Lehana, AU - Fox-Robichaud,Alison, AU - Mbuagbaw,Lawrence, AU - Szczeklik,Wojciech, AU - Alshamsi,Fayez, AU - Altayyar,Sultan, AU - Ip,Wang-Chun, AU - Li,Guowei, AU - Wang,Michael, AU - Wludarczyk,Anna, AU - Zhou,Qi, AU - Guyatt,Gordon H, AU - Cook,Deborah J, AU - Jaeschke,Roman, AU - Annane,Djillali, AU - ,, PY - 2014/7/23/entrez PY - 2014/7/23/pubmed PY - 2014/10/25/medline SP - 347 EP - 55 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 161 IS - 5 N2 - 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. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/25047428/full_citation L2 - https://www.annals.org/aim/fullarticle/doi/10.7326/M14-0178 DB - PRIME DP - Unbound Medicine ER -