Eman E. Shaban; Mohamed AM Elgassim; Ahmed Shaban; Amira Shaban; Amina Ahmed; Amro Abdelraman; Moayad Elgassim; Stuart A Lloyd; Hany A. Zaki
Articles in Press, Accepted Manuscript, Available Online from 06 October 2024
Abstract
Objective: The present study was performed to investigate the efficacy of different resuscitation fluids incritically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, andGoogle Scholar for randomized trials ...
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Objective: The present study was performed to investigate the efficacy of different resuscitation fluids incritically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, andGoogle Scholar for randomized trials published in English from January 1990 to August 2023. The risk of biasand methodological quality assessment was performed using Cochrane’s risk of bias tool embedded withinthe Review Manager software (RevMan 5.4.1). Moreover, this software was used to perform all the statisticalanalyses in the present study. During these analyses, the random effects model and 95% confidence intervalwas employed. The overall effect sizes for continuous and dichotomous data were calculated using the MeanDifference (MD) and Risk ratio (RR), respectively.Results: Our initial database search resulted in 4768 articles, of which only 16 were reviewed and analyzed.A subgroup analysis of data from 4 of these studies showed that hydroxyethyl starches (HES), gelatins andalbumins had no significant mortality benefit compared to crystalloids (RR: 0.94; 95% CI: 0.75–1.17; P=0.58,RR: 0.71; 95% 0.46–1.08; P=0.11 and RR: 1.05; 95% CI: 0.77–1.43; P=0.77, respectively). Similarly, a subgroupanalysis of data from 9 studies showed that hypertonic saline plus dextran (HSD) had no significant mortalitybenefit over normal saline (RR: 0.84; 95% CI: 0.62–1.13; P=0.24) or Lactated ringer’s solution (RR: 1.03; 95%CI: 0.75–1.42; P=0.87). In addition, we found that hypertonic saline had a similar effect on the overall mortalityas isotonic crystalloids (RR: 0.92; 95% CI: 0.68–1.25; P=0.60). Also, our analysis shows that modified fluidgelatins had a similar mortality effect as HES ((RR: 1.02; 95% CI: 0.52–2.02; P=0.95).Conclusion: Colloids, whether individually or in hypertonic crystalloids (HSD), had no mortality benefit overcrystalloids in adult patients with hypovolemic shock.