by Chien-Hua Tseng, Tzu-Tao Chen, Mei-Yi Wu, Ming-Cheng
Chan, Ming-Chieh Shih and Yu-Kang Tu
Critical Care volume 24,
Article number: 693 (2020) Published: 14
December 2020
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.
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