Uhlig Christopher, Silva Pedro L, Deckert Stefanie, Schmitt Jochen, de Abreu Marcelo Gama
Crit Care. 2014 Jan 9;18(1):R10. doi: 10.1186/cc13187.
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.
Randomized controlled trials (RCTs) were identified through a systematic literature search of MEDLINE, EMBASE, CENTRAL and LILACS. Articles published up to 15th 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.
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 PaO2/FiO2 (mmHg) improved in the first 48 hours (WMD = 62, 95% CI 47 to 77, P <0.001, I2 = 0%) after therapy start and remained stable after 7 days (WMD = 20, 95% CI 4 to 36, P = 0.017, I2 = 0%).
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.
对于急性呼吸窘迫综合征（ARDS）患者，可能需要进行液体治疗。本系统评价和荟萃分析的目的是确定与晶体液相比，胶体液治疗对ARDS成年患者死亡率和氧合的影响。
通过对MEDLINE、EMBASE、CENTRAL和LILACS进行系统文献检索，识别随机对照试验（RCT）。对截至2013年2月15日发表的文章进行独立筛选、提取和评估（采用Cochrane偏倚风险工具），以提供基于证据的治疗建议。如果RCT比较了胶体液与晶体液治疗对ARDS成年患者肺功能、炎症、损伤或死亡率的影响，则该RCT符合纳入标准。主要结局参数为呼吸力学、气体交换、肺部炎症和损伤以及医院死亡率。肾功能、肾脏替代治疗需求、血流动力学稳定和重症监护病房（ICU）住院时间作为次要结局。
在数据库中找到的4130项潜在试验中，共选择了3项RCT进行定性和定量分析，总计206例接受白蛋白或生理盐水治疗的患者。在已识别的试验中，总体偏倚风险为不清楚至高。计算得出的合并死亡风险无统计学意义（白蛋白组为100例中的34例（34.0%），生理盐水组为104例中的40例（38.5%），相对风险（RR）=0.89，95%置信区间（CI）为0.62至1.28，P=0.539）。治疗开始后48小时内，动脉血氧分压/吸入氧分数值（PaO2/FiO2，mmHg）的加权平均差（WMD）有所改善（WMD=62，95%CI为47至77，P<0.001，I2=0%），7天后保持稳定（WMD=20，95%CI为4至36，P=0.017，I2=0%）。
非常需要进行RCT来研究胶体液对ARDS患者的影响。基于本综述的结果，白蛋白胶体液治疗可改善氧合，但不影响死亡率。
