Improved Outcome Based on Fluid Management in Critically Ill Patients Requiring Pulmonary Artery Catheterization

Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis

“…The use of random sequence generation and allocation concealment [19][20][21][22]25] and the risk of reporting bias [18,[20][21][22]25] were unclear in a number of studies. While blinding was used in only 2 studies [17,18], likely due to difficulties in concealment of the different fluid regimens and/or haemodynamic monitoring technologies employed, strict protocolisation of fluid and diuretic use was felt to ameliorate the effects of this potential bias in all but two studies [19,21].…”

“…Five studies [16][17][18][19][20] took place in the United States, three in China [21][22][23], one in France [24] one in India [25] and one in Denmark and Finland [26]. Sample sizes ranged from 29 [21] to 1000 [16].…”

“…One was conducted in children [25] and the remainder in adults. Five studies included only patients with ARDS [16-18, 21, 22], four included only patients with septic shock [19,[24][25][26]; one included patients with ARDS, septic shock, or both [23] and one included a mixed critically ill population, the majority of whom had sepsis, ARDS, or both [20]. Further characteristics of included randomised trials are presented in Table 1.…”

“…Eleven studies (2051 patients) reported mortality as an outcome with variable duration of follow-up, including 90-day [26], 60-day [16, 21, 22], in-hospital [19,20] and 28 or 30-day mortality [17,18,[23][24][25]. We found no significant difference in mortality between patients receiving a conservative or deresuscitative fluid strategy compared with those receiving a liberal strategy or standard care (pooled RR 0.92; 95% confidence interval [CI] 0.82-1.02, I 2 =0%) ( Figure 3).…”

“…In three studies [16][17][18], protocolised diuretic use was used in the conservative / deresuscitative arm, in four the intervention strategy involved protocolised fluid restriction or minimisation [16,19,25,26]; and in five the main intervention was the use of alternative haemodynamic targets for fluid management, based on extravascular lung water (EVLW) [20][21][22], pulse pressure variation (PPV) [24], or intrathoracic blood volume index (ITBVI) [23]. In two trials hyperoncotic albumin infusions were used to potentiate diuresis in a deresuscitative group [17,18].…”