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

Abstract

Introduction: 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.

Aim: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.