TY - JOUR

T1 - Lower vs Higher Fluid Volumes During Initial Management of Sepsis

T2 - A Systematic Review With Meta-Analysis and Trial Sequential Analysis

AU - Meyhoff, Tine Sylvest

AU - Møller, Morten Hylander

AU - Hjortrup, Peter Buhl

AU - Cronhjort, Maria

AU - Perner, Anders

AU - Wetterslev, Jørn

N1 - Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

PY - 2020/6

Y1 - 2020/6

N2 - OBJECTIVE: IV fluids are recommended during the initial management of sepsis, but the quality of evidence is low, and clinical equipoise exists. We aimed to assess patient-important benefits and harms of lower vs higher fluid volumes in adult patients with sepsis.METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials of IV fluid volume separation in adult patients with sepsis. We adhered to our published protocol; the Cochrane handbook; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and the Grading of Recommendations Assessment, Development and Evaluation statements. The primary outcomes were all-cause mortality, serious adverse events (SAEs), and quality of life.RESULTS: We included nine trials (n = 637); all were published after 2015 and had an overall high risk of bias. We found no statistically significant difference between lower vs higher fluid volumes in all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.69-1.10; I2 = 0%; TSA-adjusted CI, 0.34-2.22) or SAEs (RR, 0.91; 95% CI, 0.78-1.05; I2 = 0%; TSA-adjusted CI, 0.68-1.21). No trials reported on quality of life. We did not find differences in the secondary or exploratory outcomes. The quality of evidence was very low across all outcomes.CONCLUSIONS: In this systematic review, we found very low quantity and quality of evidence supporting the decision on the volumes of IV fluid therapy in adults with sepsis.TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03668236; URL: www.clinicaltrials.gov.

AB - OBJECTIVE: IV fluids are recommended during the initial management of sepsis, but the quality of evidence is low, and clinical equipoise exists. We aimed to assess patient-important benefits and harms of lower vs higher fluid volumes in adult patients with sepsis.METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials of IV fluid volume separation in adult patients with sepsis. We adhered to our published protocol; the Cochrane handbook; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and the Grading of Recommendations Assessment, Development and Evaluation statements. The primary outcomes were all-cause mortality, serious adverse events (SAEs), and quality of life.RESULTS: We included nine trials (n = 637); all were published after 2015 and had an overall high risk of bias. We found no statistically significant difference between lower vs higher fluid volumes in all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.69-1.10; I2 = 0%; TSA-adjusted CI, 0.34-2.22) or SAEs (RR, 0.91; 95% CI, 0.78-1.05; I2 = 0%; TSA-adjusted CI, 0.68-1.21). No trials reported on quality of life. We did not find differences in the secondary or exploratory outcomes. The quality of evidence was very low across all outcomes.CONCLUSIONS: In this systematic review, we found very low quantity and quality of evidence supporting the decision on the volumes of IV fluid therapy in adults with sepsis.TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03668236; URL: www.clinicaltrials.gov.

U2 - 10.1016/j.chest.2019.11.050

DO - 10.1016/j.chest.2019.11.050

M3 - Journal article

C2 - 31982391

VL - 157

SP - 1478

EP - 1496

JO - Chest

JF - Chest

SN - 0012-3692

IS - 6

ER -