Document Type : Review Article

Authors

• Eman E. Shaban ¹
• Mohamed AM Elgassim ²
• Ahmed Shaban ³
• Amira Shaban ⁴
• Amina Ahmed ²
• Amro Abdelraman ⁵
• Moayad Elgassim ⁶
• Stuart A Lloyd ⁵
• Hany A. Zaki ⁵

¹ Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Qatar

² Hamad General Hospital

³ Internal Medicine - Mansoura General Hospital, Egypt.

⁴ Internal Medicine - Mansoura University Hospital, Egypt.

⁵ Hamad Medical Corporation

⁶ Taylors University Lakeside Campus

Abstract

Objective: The present study was performed to investigate the efficacy of different resuscitation fluids in
critically ill patients presenting any type of hypovolemic shock.
Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, and
Google Scholar for randomized trials published in English from January 1990 to August 2023. The risk of bias
and methodological quality assessment was performed using Cochrane’s risk of bias tool embedded within
the Review Manager software (RevMan 5.4.1). Moreover, this software was used to perform all the statistical
analyses in the present study. During these analyses, the random effects model and 95% confidence interval
was employed. The overall effect sizes for continuous and dichotomous data were calculated using the Mean
Difference (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 and
albumins 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 subgroup
analysis of data from 9 studies showed that hypertonic saline plus dextran (HSD) had no significant mortality
benefit 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 mortality
as isotonic crystalloids (RR: 0.92; 95% CI: 0.68–1.25; P=0.60). Also, our analysis shows that modified fluid
gelatins 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 over
crystalloids in adult patients with hypovolemic shock.

Keywords

• Fluid resuscitation
• hypovolemic shock
• critically ill