Clinical efficacy of various resuscitation fluids in the management of sepsis in postoperative surgical and trauma patients: a systematic review and meta­‐analysis

TL;DR

This study compares different fluids used to treat sepsis in critically ill patients and finds Ringer’s lactate to be most effective in reducing deaths and improving blood flow.

Contribution

The study provides a meta-analysis comparing the clinical efficacy of various resuscitation fluids in sepsis management.

Findings

Ringer’s lactate reduces all-cause mortality more effectively than saline, albumin, and hydroxyethyl starch.

Ringer’s lactate improves hemodynamic parameters better than other fluids in septic patients.

Saline performs better than albumin and hydroxyethyl starch in some endpoints.

Abstract

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.

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.

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, I2 statistic, and the appropriate P value.

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; χ2= 3.47; degree of freedom [df] = 6; Z = 4.6; I2 = 0%; P <⁠0.001) and improving hemodynamic parameters (OR, 2.64; 95% CI, 2.45–2.86; χ2 = 48.36; df = 6; Z = 24.84; I2 = 18%; P <⁠0.001). However, saline was superior to albumin and hydroxyethyl starch in reaching these end points.

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.

Figures