TY - JOUR
T1 - Fluid resuscitation in sepsis
T2 - A systematic review and network meta-analysis
AU - Fluids in Sepsis and Septic Shock Group
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 - Włudarczyk, Anna
AU - Zhou, Qi
AU - Guyatt, Gordon H.
AU - Cook, Deborah J.
AU - Jaeschke, Roman
AU - Annane, Djillali
PY - 2014/9/2
Y1 - 2014/9/2
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 (18 916 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.
AB - 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 (18 916 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.
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U2 - 10.7326/M14-0178
DO - 10.7326/M14-0178
M3 - Review article
C2 - 25047428
AN - SCOPUS:84906990494
SN - 0003-4819
VL - 161
SP - 347
EP - 355
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 5
ER -