Qayyum Shahid, Shahid Kamran
Nephrology, Diaverum Dialysis Center, Wadi Al Dawasir, SAU.
Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2023 Aug 29;15(8):e44317. doi: 10.7759/cureus.44317. eCollection 2023 Aug.
Sepsis is a life-threatening organ failure caused by a dysregulated response to infection. Fluid resuscitation and vasopressors are used to maintain systolic blood pressure and organ perfusion. Fluid resuscitation can be done with liberal or restricted fluids as well as colloids or crystalloid fluids. This review analyses the evidence for the use of liberal or restrictive fluids and colloids or crystalloids for the management of sepsis. A methodical search was conducted across PubMed, Cochrane Library, and ScienceDirect, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed for this study. Randomized controlled trials and retrospective observational studies were included in this study. Liberal and restrictive fluid strategies were found to be comparable in efficacy, but restrictive fluid regimens had the added benefit of a lower incidence of fluid overload. Balanced crystalloids were safer and more effective when compared to normal saline. Albumin replacement was found to be safe and showed efficacy in reducing mortality in patients with sepsis and septic shock.
脓毒症是一种因对感染的反应失调而导致的危及生命的器官衰竭。液体复苏和血管加压药用于维持收缩压和器官灌注。液体复苏可以使用大量或限制量的液体以及胶体或晶体液。本综述分析了使用大量或限制性液体以及胶体或晶体液治疗脓毒症的证据。我们在PubMed、Cochrane图书馆和ScienceDirect上进行了系统检索,并遵循系统评价和Meta分析的首选报告项目(PRISMA)2020指南进行本研究。本研究纳入了随机对照试验和回顾性观察性研究。发现大量和限制性液体策略在疗效上相当,但限制性液体方案还有液体超负荷发生率较低的额外益处。与生理盐水相比,平衡晶体液更安全、更有效。发现白蛋白替代疗法安全,且在降低脓毒症和感染性休克患者死亡率方面显示出疗效。