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Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis

OBJECTIVE: The aim of this study was to compare the effectiveness of different fluids on critically ill patients who need fluid resuscitation through a systematic review and network meta-analysis (NMA). DATA SOURCES: Electronic databases were searched up to March 2018 for randomized controlled trial...

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Autores principales: Liu, Chao, Mao, Zhi, Hu, Pan, Hu, Xin, Kang, Hongjun, Hu, Jie, Yang, Zhifang, Ma, Penglin, Zhou, Feihu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143126/
https://www.ncbi.nlm.nih.gov/pubmed/30254452
http://dx.doi.org/10.2147/TCRM.S175080
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author Liu, Chao
Mao, Zhi
Hu, Pan
Hu, Xin
Kang, Hongjun
Hu, Jie
Yang, Zhifang
Ma, Penglin
Zhou, Feihu
author_facet Liu, Chao
Mao, Zhi
Hu, Pan
Hu, Xin
Kang, Hongjun
Hu, Jie
Yang, Zhifang
Ma, Penglin
Zhou, Feihu
author_sort Liu, Chao
collection PubMed
description OBJECTIVE: The aim of this study was to compare the effectiveness of different fluids on critically ill patients who need fluid resuscitation through a systematic review and network meta-analysis (NMA). DATA SOURCES: Electronic databases were searched up to March 2018 for randomized controlled trials comparing the effectiveness of different fluids in critically ill patients. The primary outcome was mortality, and the secondary outcomes were the incident of acute kidney injury (AKI) and risk of receiving renal replacement therapy (RRT). A Bayesian NMA was conducted, and the quality of evidence contributing to each network estimate was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria. RESULTS: We deemed 49 trials eligible, including 40,910 participants. The quality of evidence was rated as moderate in most comparisons. There was no significant difference among resuscitation fluids in mortality. NMA at the 9-node level showed the most effective fluid was balanced crystalloid (BC) (80.79%, the ranking of resuscitation fluid based on cumulative probability plots and surface under the cumulative ranking curves [SUCRAs]). NMA at the 10-node level showed that the most effective fluid was Plasma-Lyte (77.52%). Results of sensitivity analyses in mortality did not reveal any significant changes in the findings for primary outcomes. High-molecular-weight hetastarch (H-HES) was associated with an increased incidence of AKI when compared with gelatin (odds ratio [OR], 0.43; 95% credibility interval [CrI], 0.19–0.94), low-molecular-weight hetastarch (L-HES; OR, 0.50; 95% CrI, 0.30–0.87), BC (OR, 0.55; 95% CrI, 0.34–0.88), and normal saline (OR, 0.56; 95% CrI, 0.34–0.93). Meanwhile, H-HES was also associated with an increased risk of receiving RRT when compared with BC (OR, 0.51; 95% CrI, 0.27–0.93) and normal saline (OR, 0.52; 95% CrI, 0.24–0.96). CONCLUSION: BCs, especially the Plasma-Lyte, are presumably the best choice for most critically ill patients who need fluid resuscitation. Meanwhile, the use of H-HES was associated with an increased incidence of AKI and risk of receiving RRT. REGISTRATION: PROSPERO (CRD42017072728).
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spelling pubmed-61431262018-09-25 Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis Liu, Chao Mao, Zhi Hu, Pan Hu, Xin Kang, Hongjun Hu, Jie Yang, Zhifang Ma, Penglin Zhou, Feihu Ther Clin Risk Manag Original Research OBJECTIVE: The aim of this study was to compare the effectiveness of different fluids on critically ill patients who need fluid resuscitation through a systematic review and network meta-analysis (NMA). DATA SOURCES: Electronic databases were searched up to March 2018 for randomized controlled trials comparing the effectiveness of different fluids in critically ill patients. The primary outcome was mortality, and the secondary outcomes were the incident of acute kidney injury (AKI) and risk of receiving renal replacement therapy (RRT). A Bayesian NMA was conducted, and the quality of evidence contributing to each network estimate was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria. RESULTS: We deemed 49 trials eligible, including 40,910 participants. The quality of evidence was rated as moderate in most comparisons. There was no significant difference among resuscitation fluids in mortality. NMA at the 9-node level showed the most effective fluid was balanced crystalloid (BC) (80.79%, the ranking of resuscitation fluid based on cumulative probability plots and surface under the cumulative ranking curves [SUCRAs]). NMA at the 10-node level showed that the most effective fluid was Plasma-Lyte (77.52%). Results of sensitivity analyses in mortality did not reveal any significant changes in the findings for primary outcomes. High-molecular-weight hetastarch (H-HES) was associated with an increased incidence of AKI when compared with gelatin (odds ratio [OR], 0.43; 95% credibility interval [CrI], 0.19–0.94), low-molecular-weight hetastarch (L-HES; OR, 0.50; 95% CrI, 0.30–0.87), BC (OR, 0.55; 95% CrI, 0.34–0.88), and normal saline (OR, 0.56; 95% CrI, 0.34–0.93). Meanwhile, H-HES was also associated with an increased risk of receiving RRT when compared with BC (OR, 0.51; 95% CrI, 0.27–0.93) and normal saline (OR, 0.52; 95% CrI, 0.24–0.96). CONCLUSION: BCs, especially the Plasma-Lyte, are presumably the best choice for most critically ill patients who need fluid resuscitation. Meanwhile, the use of H-HES was associated with an increased incidence of AKI and risk of receiving RRT. REGISTRATION: PROSPERO (CRD42017072728). Dove Medical Press 2018-09-12 /pmc/articles/PMC6143126/ /pubmed/30254452 http://dx.doi.org/10.2147/TCRM.S175080 Text en © 2018 Liu et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Liu, Chao
Mao, Zhi
Hu, Pan
Hu, Xin
Kang, Hongjun
Hu, Jie
Yang, Zhifang
Ma, Penglin
Zhou, Feihu
Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
title Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
title_full Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
title_fullStr Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
title_full_unstemmed Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
title_short Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
title_sort fluid resuscitation in critically ill patients: a systematic review and network meta-analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143126/
https://www.ncbi.nlm.nih.gov/pubmed/30254452
http://dx.doi.org/10.2147/TCRM.S175080
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