scholarly journals Resuscitation fluid types in sepsis, surgical, and trauma patients: A Systematic review and sequential network meta-analyses

2020 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced acute kidney injury more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES, was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.

scholarly journals Resuscitation fluid types in sepsis, surgical, and trauma patients: A Systematic review and sequential network meta-analyses

2020 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced acute kidney injury more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87). Conclusions: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline did in sepsis patients; however, saline or L-HES, is better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.

scholarly journals Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be inferred from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. Confidence in Network Meta-Analysis (CINeMA) web application was used to rate confidence in synthetic evidence. Results Fifty-eight trials (n = 26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR 0.84; 95% CI 0.74–0.95) and L-HES (OR 0.81; 95% CI 0.69–0.95) and reduced acute kidney injury more than L-HES (OR 0.80; 95% CI 0.65–0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR 0.55; 95% CI 0.35–0.87). Conclusions Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients. Trial registration PROSPERO website, registration number: CRD42018115641).

scholarly journals Resuscitation Fluid Types in Sepsis, Surgical, and Trauma Patients: A Systematic Review and Sequential Network Meta-analyses

2020 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Brain Injury ◽  
Web Application ◽  
Meta Analysis ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with serious adverse events (AEs). Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and other AEs is not comprehensive. This study aims to compare the survival benefits and AEs of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer renal AEs, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced renal AEs more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the largest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: For sepsis and surgical patients, we recommend balanced crystalloids and albumin, rather than L-HES and saline. For traumatic brain injury patients, we recommend saline or L-HES, rather than iso-oncotic albumin or balanced crystalloids. These findings could guide physicians’ fluid selection.Trial registry: PROSPERO website, registration number: CRD42018115641).

scholarly journals A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study—Associations With Acute Kidney Injury and Mortality

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Markus B. Skrifvars ◽  
Michael Bailey ◽  
Elizabeth Moore ◽  
Johan Mårtensson ◽  
Craig French ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Kidney Injury ◽  
Post Hoc Analysis ◽  
Post Hoc

scholarly journals Incidence and Burden of Acute Kidney Injury among Traumatic Brain-Injury Patients

2021 ◽  
Vol Volume 14 ◽  
pp. 4571-4580
Author(s):  
Ruoran Wang ◽  
Jing Zhang ◽  
Jing Xu ◽  
Min He ◽  
Jianguo Xu
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Kidney Injury

Assessment of Early Tracheostomy in Trauma Patients: A Systematic Review and Meta-Analysis

2006 ◽  
Vol 72 (3) ◽  
pp. 276-281 ◽  
Author(s):  
C. Michael Dunham ◽  
Kenneth J. Ransom
Keyword(s):  
Brain Injury ◽  
Fixed Effects ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Trauma Patients ◽  
Severe Brain Injury ◽  
Early Tracheostomy ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Patient Studies

The objective of this review was to assess outcomes in trauma patients undergoing early tracheostomy (ET). Abstract databases for the Eastern and American Associations for the Surgery of Trauma and Medline were searched to find trauma patient studies comparing ET and late tracheostomy (LT) or ET and no ET. Fixed-effects meta-analyses were performed on the randomized controlled trial (RCT) studies. Of five retrospective and four RCT studies, none demonstrated survival benefit or harm with ET (P > 0.05). In five RCT studies of ET and no ET, ET pneumonia rates were similar to the no ET group (relative risk 1.00 [95% confidence intervals 0.88–1.15], P = 0.97). In five RCT studies of ET and no ET, ET ventilator/intensive care unit (ICU) days were similar to the no ET group (P = 0.27). In the two severe brain injury studies, ET ventilator/ICU days were lower than the no ET group (P = 0.06). In the three nonbrain injury studies, ET ventilator/ICU days were similar to the no ET group (P = 0.79). Five studies described similar laryngotracheal pathology rates with ET and no ET or LT (P > 0.05). In conclusion, ET has no influence on mortality, pneumonia, or laryngotracheal pathology rates in trauma patients. Patients with severe brain injury may be more rapidly liberated from mechanical ventilation with ET. However, additional research is needed.

scholarly journals The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 44 (12) ◽  
pp. 4106-4117
Author(s):  
David Rösli ◽  
Beat Schnüriger ◽  
Daniel Candinas ◽  
Tobias Haltmeier
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Accidental Hypothermia ◽  
Trauma Patients ◽  
Qualitative Synthesis ◽  
Pubmed Database ◽  
The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

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