Hsiao Kai Hsun, Kalanzi Joseph, Watson Stuart B, Murthy Srinivas, Movsisyan Ani, Kothari Kavita, Salio Flavio, Relan Pryanka
Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, Switzerland.
Department of Anaesthesia, Critical Care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Burns Open. 2024 Nov;8(4):None. doi: 10.1016/j.burnso.2024.100364.
Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative.
To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns.
PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE.
Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33-5.36) but the evidence is very uncertain, and no difference in urine output (SMD -0.17, 95% CI -0.65-0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72-476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8-28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55-1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08-1.09), improved creatinine levels (SMD -3.48, 95% CI -4.69 to -2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38-0.72).
Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered.
在大规模伤亡烧伤事件中，对严重烧伤患者进行及时、安全的静脉输液复苏可能困难甚至无法实现。口服/肠内补液复苏可能是一种替代方法。
综合并评估与静脉输液或不进行液体复苏相比，口服/肠内补液复苏治疗严重烧伤的证据确定性。
于2023年9月8日检索了PubMed、EMBASE、CINAHL和Cochrane图书馆。纳入了由两名评审员评估符合标准的主要定量研究。对口服/肠内与静脉输液以及口服/肠内与不进行液体复苏的结局效应进行了荟萃分析。使用GRADE评估证据确定性。
纳入了7项人体研究和8项动物研究。三项共100名参与者的人体随机对照试验有助于估计。与静脉输液复苏相比，口服/肠内补液复苏与死亡率增加的风险在统计学上无显著差异（比值比1.33，95%置信区间0.33 - 5.36），但证据非常不确定，且尿量无差异（标准化均数差 -0.17，95%置信区间 -0.65 - 0.31），证据确定性为中等。八项共212名参与者的对照动物研究有助于估计。从这些动物研究来看，与静脉输液相比，肠内补液复苏可能增加死亡率（比值比36.00，95%置信区间2.72 - 476.28），使肌酐水平恶化（平均差22 mmol/L，95%置信区间15.8 - 28.2），并增加尿量（平均差1 ml/kg/h，95%置信区间0.55 - 1.45），但所有证据确定性都非常低。同样，从动物研究来看，所有证据都非常不确定，但与不进行液体复苏相比，肠内复苏与死亡率在统计学上无显著降低相关（比值比0.29，95%置信区间0.08 - 1.09），肌酐水平改善（标准化均数差 -3.48，95%置信区间 -4.69至 -2.28），尿量增加（平均差0.55 ml/kg/h，95%置信区间0.38 - 0.72）。
目前比较口服/肠内和静脉输液复苏治疗严重烧伤的证据有限且不确定。然而，在无法进行或延迟进行静脉输液复苏的情况下，可以考虑口服补液复苏。
