https://scholars.lib.ntu.edu.tw/handle/123456789/533422
Title: | Liberal versus restricted fluid resuscitation strategies in trauma patients: A systematic review and meta-analysis of randomized controlled trials and observational studies | Authors: | CHIH-HUNG WANG Hsieh W.-H. Chou H.-C. Huang Y.-S. Shen J.-H. Yeo Y.H. Chang H.-E. SHYR-CHYR CHEN CHIEN-CHANG LEE |
Issue Date: | 2014 | Journal Volume: | 42 | Journal Issue: | 4 | Start page/Pages: | 954-961 | Source: | Critical Care Medicine | Abstract: | Objective: Hemorrhage is responsible for most deaths that occur during the first few hours after trauma. Animal models of trauma have shown that restricting fluid administration can reduce the risk of death; however, studies in patients are difficult to conduct due to logistical and ethical problems. To maximize the value of the existing evidence, we performed a meta-analysis to compare liberal versus restricted fluid resuscitation strategies in trauma patients. DATA SOURCES: Medline and Embase were systemically searched from inception to February 2013. STUDY SELECTION: We selected randomized controlled trials and observational studies that compared different fluid administration strategies in trauma patients. There were no restrictions for language, population, or publication year. DATA EXTRACTION: Four randomized controlled trials and seven observational studies were identified from 1,106 references. One of the randomized controlled trials suffered from a high protocol violation rate and was excluded from the final analysis. DATA SYNTHESIS: The quantitative synthesis indicated that liberal fluid resuscitation strategies might be associated with higher mortality than restricted fluid strategies, both in randomized controlled trials (risk ratio, 1.25; 95% CI, 1.01-1.55; three trials; I, 0) and observational studies (odds ratio, 1.14; 95% CI, 1.01-1.28; seven studies; I, 21.4%). When only adjusted odds ratios were pooled for observational studies, odds for mortality with liberal fluid resuscitation strategies increased (odds ratio, 1.19; 95% CI, 1.02-1.38; six studies; I, 26.3%). Conclusions: Current evidence indicates that initial liberal fluid resuscitation strategies may be associated with higher mortality in injured patients. However, available studies are subject to a high risk of selection bias and clinical heterogeneity. This result should be interpreted with great caution. ? 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/533422 | ISSN: | 0090-3493 | DOI: | 10.1097/CCM.0000000000000050 | SDG/Keyword: | article; bleeding; case control study; data synthesis; fluid resuscitation; follow up; health care planning; human; injury; intermethod comparison; liberal fluid resuscitation; meta analysis; mortality; observational study; priority journal; quality control; randomized controlled trial (topic); restricted fluid resuscitation; systematic review; systolic blood pressure; Fluid Therapy; Hemorrhage; Humans; Observational Study as Topic; Randomized Controlled Trials as Topic; Resuscitation; Wounds and Injuries |
Appears in Collections: | 醫學院附設醫院 (臺大醫院) |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.