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Lower versus higher fluid volumes during initial management of sepsis - a systematic review with meta-analysis and trial sequential analysis

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@article{56a40bd9eb4c4591bba99d8f7287d82b,
title = "Lower versus higher fluid volumes during initial management of sepsis - a systematic review with meta-analysis and trial sequential analysis",
abstract = "PURPOSE: Intravenous 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 versus higher fluid volumes in adult patients with sepsis.METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials of intravenous 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 and quality-of-life.RESULTS: We included 9 trials (n=637); all were published after 2015 and had overall high risk of bias. We found no statistically significant difference between lower versus higher fluid volumes on all-cause mortality (relative risk 0.87, 95{\%} confidence interval (CI) 0.69 to 1.10, I2=0{\%}; TSA adjusted Cl 0.34 to 2.22), or serious adverse events (relative risk 0.91 95{\%} CI 0.78 to 1.05, I2=0{\%}; TSA adjusted CI 0.68 to 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.",
author = "Meyhoff, {Tine Sylvest} and M{\o}ller, {Morten Hylander} and Hjortrup, {Peter Buhl} and Maria Cronhjort and Anders Perner and J{\o}rn Wetterslev",
note = "Copyright {\circledC} 2020. Published by Elsevier Inc.",
year = "2020",
month = "1",
day = "23",
doi = "10.1016/j.chest.2019.11.050",
language = "English",
volume = "20",
pages = "30123--9",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",

}

RIS

TY - JOUR

T1 - Lower versus higher fluid volumes during initial management of sepsis - 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. Published by Elsevier Inc.

PY - 2020/1/23

Y1 - 2020/1/23

N2 - PURPOSE: Intravenous 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 versus higher fluid volumes in adult patients with sepsis.METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials of intravenous 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 and quality-of-life.RESULTS: We included 9 trials (n=637); all were published after 2015 and had overall high risk of bias. We found no statistically significant difference between lower versus higher fluid volumes on all-cause mortality (relative risk 0.87, 95% confidence interval (CI) 0.69 to 1.10, I2=0%; TSA adjusted Cl 0.34 to 2.22), or serious adverse events (relative risk 0.91 95% CI 0.78 to 1.05, I2=0%; TSA adjusted CI 0.68 to 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.

AB - PURPOSE: Intravenous 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 versus higher fluid volumes in adult patients with sepsis.METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials of intravenous 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 and quality-of-life.RESULTS: We included 9 trials (n=637); all were published after 2015 and had overall high risk of bias. We found no statistically significant difference between lower versus higher fluid volumes on all-cause mortality (relative risk 0.87, 95% confidence interval (CI) 0.69 to 1.10, I2=0%; TSA adjusted Cl 0.34 to 2.22), or serious adverse events (relative risk 0.91 95% CI 0.78 to 1.05, I2=0%; TSA adjusted CI 0.68 to 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.

U2 - 10.1016/j.chest.2019.11.050

DO - 10.1016/j.chest.2019.11.050

M3 - Journal article

VL - 20

SP - 30123

EP - 30129

JO - Chest

JF - Chest

SN - 0012-3692

M1 - pii: S0012-3692

ER -

ID: 59134941