Clinical Efficacy of Various Resuscitation Fluids in the Management of Sepsis in Postoperative Surgical and Trauma Patients: a Systematic Review and Meta--analysis

Overview

Journal Wideochir Inne Tech Maloinwazyjne

Publisher Termedia

Date 2025 Mar 5

PMID 40041106

Authors

Yongjie Wang

Kewu Chen

Xiaolu Li

Jianing Guan

Affiliations

Soon will be listed here.

Abstract

Introduction: Fluid resuscitation is the primary sepsis management strategy aimed at reducing mortality and achieving better treatment outcomes in critically hypotensive patients. Still, there are significant ambiguities regarding the most suitable fluid type that would ensure optimization of patient outcomes.

Aim: The aim of this systematic review and meta-analysis was to assess the clinical effectiveness of different resuscitation fluids for sepsis management in critically hypotensive patients.

Materials And Methods: A systematic search of 4 electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted to identify relevant papers published in peer-reviewed journals since database inception until June 30, 2024. Odds ratios (ORs) with 95% CIs were calculated to evaluate the impact of individual resuscitation fluids on improvements in hemodynamic parameters and all-cause mortality. Heterogeneity was assessed using the Cochran Q, I statistic, and the appropriate value.

Results: Our meta-analysis included 18 randomized controlled trials comparing the efficacy of different resuscitation fluids for sepsis management in 14 469 critically hypotensive patients. We found that Ringer's lactate solution was more effective than saline in reducing mortality (OR, 0.53; 95% CI, 0.41-0.7; χ= 3.47; degree of freedom [df] = 6; Z = 4.6; I = 0%; <⁠0.001) and improving hemodynamic parameters (OR, 2.64; 95% CI, 2.45-2.86; χ = 48.36; df = 6; Z = 24.84; I = 18%; <⁠0.001). However, saline was superior to albumin and hydroxyethyl starch in reaching these end points.

Conclusion: We showed that in critically hypotensive septic patients, Ringer's lactate solution reduces all-cause mortality and improves hemodynamic parameters more effectively than saline, hydroxyethyl starch, and albumin solutions.

References

Friedman G, Jankowski S, Shahla M, Gomez J, Vincent J . Hemodynamic effects of 6% and 10% hydroxyethyl starch solutions versus 4% albumin solution in septic patients. J Clin Anesth. 2008; 20(7):528-33. DOI: 10.1016/j.jclinane.2008.05.022. View

Moschopoulos C, Dimopoulou D, Dimopoulou A, Dimopoulou K, Protopapas K, Zavras N . New Insights into the Fluid Management in Patients with Septic Shock. Medicina (Kaunas). 2023; 59(6). PMC: 10301281. DOI: 10.3390/medicina59061047. View

Shea B, Reeves B, Wells G, Thuku M, Hamel C, Moran J . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:j4008. PMC: 5833365. DOI: 10.1136/bmj.j4008. View

Elovic A, Pourmand A . MDCalc Medical Calculator App Review. J Digit Imaging. 2019; 32(5):682-684. PMC: 6737202. DOI: 10.1007/s10278-019-00218-y. View

Szumilas M . Explaining odds ratios. J Can Acad Child Adolesc Psychiatry. 2010; 19(3):227-9. PMC: 2938757. View

Parikh R, Mathai A, Parikh S, Sekhar G, Thomas R . Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2007; 56(1):45-50. PMC: 2636062. DOI: 10.4103/0301-4738.37595. View

Liu C, Mao Z, Hu P, Hu X, Kang H, Hu J . Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis. Ther Clin Risk Manag. 2018; 14:1701-1709. PMC: 6143126. DOI: 10.2147/TCRM.S175080. View

Ramesh G, Uma J, Farhath S . Fluid resuscitation in trauma: what are the best strategies and fluids?. Int J Emerg Med. 2019; 12(1):38. PMC: 6894336. DOI: 10.1186/s12245-019-0253-8. View

Mitra S, Khandelwal P . Are all colloids same? How to select the right colloid?. Indian J Anaesth. 2010; 53(5):592-607. PMC: 2900092. View

10.

Joosten A, Delaporte A, Ickx B, Touihri K, Stany I, Barvais L . Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery. Anesthesiology. 2017; 128(1):55-66. DOI: 10.1097/ALN.0000000000001936. View

11.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R . A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004; 350(22):2247-56. DOI: 10.1056/NEJMoa040232. View

12.

Seitz K, Qian E, Semler M . Intravenous fluid therapy in sepsis. Nutr Clin Pract. 2022; 37(5):990-1003. PMC: 9463107. DOI: 10.1002/ncp.10892. View

13.

Hotchkiss R, Moldawer L, Opal S, Reinhart K, Turnbull I, Vincent J . Sepsis and septic shock. Nat Rev Dis Primers. 2017; 2:16045. PMC: 5538252. DOI: 10.1038/nrdp.2016.45. View

14.

Malbrain M, Langer T, Annane D, Gattinoni L, Elbers P, Hahn R . Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Ann Intensive Care. 2020; 10(1):64. PMC: 7245999. DOI: 10.1186/s13613-020-00679-3. View

15.

Messina A, Bakker J, Chew M, De Backer D, Hamzaoui O, Hernandez G . Pathophysiology of fluid administration in critically ill patients. Intensive Care Med Exp. 2022; 10(1):46. PMC: 9633880. DOI: 10.1186/s40635-022-00473-4. View

16.

Iskander K, Osuchowski M, Stearns-Kurosawa D, Kurosawa S, Stepien D, Valentine C . Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev. 2013; 93(3):1247-88. PMC: 3962548. DOI: 10.1152/physrev.00037.2012. View

17.

Munroe E, Hyzy R, Semler M, Shankar-Hari M, Young P, Zampieri F . Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review. Am J Respir Crit Care Med. 2023; 207(10):1283-1299. PMC: 10595457. DOI: 10.1164/rccm.202209-1831CI. View

18.

Brown D . A Review of the PubMed PICO Tool: Using Evidence-Based Practice in Health Education. Health Promot Pract. 2019; 21(4):496-498. DOI: 10.1177/1524839919893361. View

19.

Shi L, Chu H, Lin L . A Bayesian approach to assessing small-study effects in meta-analysis of a binary outcome with controlled false positive rate. Res Synth Methods. 2020; 11(4):535-552. PMC: 7343620. DOI: 10.1002/jrsm.1415. View

20.

Khatua B, Yaron J, El-Kurdi B, Kostenko S, Papachristou G, Singh V . Ringer's Lactate Prevents Early Organ Failure by Providing Extracellular Calcium. J Clin Med. 2020; 9(1). PMC: 7019478. DOI: 10.3390/jcm9010263. View