Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
Chest. 2023 Oct;164(4):892-912. doi: 10.1016/j.chest.2023.04.036. Epub 2023 May 2.
IV fluids are recommended for adults with sepsis. However, the optimal strategy for IV fluid management in sepsis is unknown, and clinical equipoise exists.
Do lower vs higher fluid volumes improve patient-important outcomes in adult patients with sepsis?
We updated a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing lower vs higher IV fluid volumes in adult patients with sepsis. The coprimary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. We followed the recommendations from the Cochrane Handbook and used the Grading of Recommendations Assessment, Development and Evaluation approach. Primary conclusions were based on trials with low risk of bias if available.
We included 13 trials (N = 4,006) with four trials (n = 3,385) added to this update. The meta-analysis of all-cause mortality in eight trials with low risk of bias showed a relative risk of 0.99 (97% CI, 0.89-1.10; moderate certainty evidence). Six trials with predefined definitions of serious adverse events showed a relative risk of 0.95 (97% CI, 0.83-1.07; low certainty evidence). Health-related quality of life was not reported.
Among adult patients with sepsis, lower IV fluid volumes probably result in little to no difference in all-cause mortality compared with higher IV fluid volumes, but the interpretation is limited by imprecision in the estimate, which does not exclude potential benefit or harm. Similarly, the evidence suggests lower IV fluid volumes result in little to no difference in serious adverse events. No trials reported on health-related quality of life.
PROSPERO; No.: CRD42022312572; URL: https://www.crd.york.ac.uk/prospero/.
对于脓毒症患者，建议使用静脉输液。然而，脓毒症患者静脉输液管理的最佳策略尚不清楚，并且存在临床平衡。
与高容量相比，较低容量的液体是否能改善脓毒症成年患者的患者重要结局？
我们对评估脓毒症成年患者较低与较高静脉输液量的随机临床试验进行了系统评价更新和荟萃分析及试验序贯分析。主要结局是全因死亡率、严重不良事件和健康相关生活质量。我们遵循 Cochrane 手册的建议，并使用推荐评估、制定与评价分级方法。如果可用，主要结论基于低偏倚风险的试验。
我们纳入了 13 项试验（N=4006），其中 4 项试验（n=3385）在此更新中增加。8 项低偏倚风险试验的全因死亡率荟萃分析显示，相对风险为 0.99（97%CI，0.89-1.10；中等确定性证据）。6 项具有预先定义的严重不良事件定义的试验显示相对风险为 0.95（97%CI，0.83-1.07；低确定性证据）。未报告健康相关生活质量。
在脓毒症成年患者中，与高静脉输液量相比，较低的静脉输液量可能导致全因死亡率几乎没有差异，但由于估计的不精确性，其解释受到限制，不能排除潜在的益处或危害。同样，证据表明较低的静脉输液量导致严重不良事件几乎没有差异。没有试验报告健康相关生活质量。
PROSPERO；编号：CRD42022312572；网址：https://www.crd.york.ac.uk/prospero/。
