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Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis

INTRODUCTION: In patients with acute respiratory distress syndrome (ARDS) fluid therapy might be necessary. The aim of this systematic review and meta-analysis is to determine the effects of colloid therapy compared to crystalloids on mortality and oxygenation in adults with ARDS. METHODS: Randomize...

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Autores principales: Uhlig, Christopher, Silva, Pedro L, Deckert, Stefanie, Schmitt, Jochen, de Abreu, Marcelo Gama
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056106/
https://www.ncbi.nlm.nih.gov/pubmed/24405693
http://dx.doi.org/10.1186/cc13187
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author Uhlig, Christopher
Silva, Pedro L
Deckert, Stefanie
Schmitt, Jochen
de Abreu, Marcelo Gama
author_facet Uhlig, Christopher
Silva, Pedro L
Deckert, Stefanie
Schmitt, Jochen
de Abreu, Marcelo Gama
author_sort Uhlig, Christopher
collection PubMed
description INTRODUCTION: In patients with acute respiratory distress syndrome (ARDS) fluid therapy might be necessary. The aim of this systematic review and meta-analysis is to determine the effects of colloid therapy compared to crystalloids on mortality and oxygenation in adults with ARDS. METHODS: Randomized controlled trials (RCTs) were identified through a systematic literature search of MEDLINE, EMBASE, CENTRAL and LILACS. Articles published up to 15(th) February 2013 were independently screened, abstracted, and assessed (Cochrane Risk of Bias Tool) to provide evidence-based therapy recommendations. RCTs were eligible if they compared colloid versus crystalloid therapy on lung function, inflammation, damage or mortality in adults with ARDS. Primary outcome parameters were respiratory mechanics, gas exchange lung inflammation and damage as well as hospital mortality. Kidney function, need for renal replacement therapy, hemodynamic stabilization and intensive care unit (ICU) length of stay served as secondary outcomes. RESULTS: A total of 3 RCTs out of 4130 potential trials found in the databases were selected for qualitative and quantitative analysis totaling 206 patients who received either albumin or saline. Overall risk of bias was unclear to high in the identified trials. Calculated pooled risk of death was not statistically significant (albumin 34 of 100 (34.0%) versus 40 of 104 (38.5%), relative risk (RR) = 0.89, 95% confidence interval (CI) 0.62 to 1.28, P = 0.539). Weighted mean difference (WMD) in PaO(2)/FiO(2) (mmHg) improved in the first 48 hours (WMD = 62, 95% CI 47 to 77, P <0.001, I(2) = 0%) after therapy start and remained stable after 7 days (WMD = 20, 95% CI 4 to 36, P = 0.017, I(2) = 0%). CONCLUSIONS: There is a high need for RCTs investigating the effects of colloids in ARDS patients. Based on the findings of this review, colloid therapy with albumin improved oxygenation but did not affect mortality.
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spelling pubmed-40561062014-06-14 Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis Uhlig, Christopher Silva, Pedro L Deckert, Stefanie Schmitt, Jochen de Abreu, Marcelo Gama Crit Care Research INTRODUCTION: In patients with acute respiratory distress syndrome (ARDS) fluid therapy might be necessary. The aim of this systematic review and meta-analysis is to determine the effects of colloid therapy compared to crystalloids on mortality and oxygenation in adults with ARDS. METHODS: Randomized controlled trials (RCTs) were identified through a systematic literature search of MEDLINE, EMBASE, CENTRAL and LILACS. Articles published up to 15(th) February 2013 were independently screened, abstracted, and assessed (Cochrane Risk of Bias Tool) to provide evidence-based therapy recommendations. RCTs were eligible if they compared colloid versus crystalloid therapy on lung function, inflammation, damage or mortality in adults with ARDS. Primary outcome parameters were respiratory mechanics, gas exchange lung inflammation and damage as well as hospital mortality. Kidney function, need for renal replacement therapy, hemodynamic stabilization and intensive care unit (ICU) length of stay served as secondary outcomes. RESULTS: A total of 3 RCTs out of 4130 potential trials found in the databases were selected for qualitative and quantitative analysis totaling 206 patients who received either albumin or saline. Overall risk of bias was unclear to high in the identified trials. Calculated pooled risk of death was not statistically significant (albumin 34 of 100 (34.0%) versus 40 of 104 (38.5%), relative risk (RR) = 0.89, 95% confidence interval (CI) 0.62 to 1.28, P = 0.539). Weighted mean difference (WMD) in PaO(2)/FiO(2) (mmHg) improved in the first 48 hours (WMD = 62, 95% CI 47 to 77, P <0.001, I(2) = 0%) after therapy start and remained stable after 7 days (WMD = 20, 95% CI 4 to 36, P = 0.017, I(2) = 0%). CONCLUSIONS: There is a high need for RCTs investigating the effects of colloids in ARDS patients. Based on the findings of this review, colloid therapy with albumin improved oxygenation but did not affect mortality. BioMed Central 2014 2014-01-09 /pmc/articles/PMC4056106/ /pubmed/24405693 http://dx.doi.org/10.1186/cc13187 Text en Copyright © 2014 Uhlig et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Uhlig, Christopher
Silva, Pedro L
Deckert, Stefanie
Schmitt, Jochen
de Abreu, Marcelo Gama
Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
title Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
title_full Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
title_fullStr Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
title_full_unstemmed Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
title_short Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
title_sort albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056106/
https://www.ncbi.nlm.nih.gov/pubmed/24405693
http://dx.doi.org/10.1186/cc13187
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