Reviving the Critically Ill: Exploring Effective Fluid Resuscitation Approaches for Diverse Hypovolemic Shock Cases–A Systematic Review and Meta-Analysis

Abstract

Objective: The present study was performed to investigate the efficacy of different resuscitation fluids in critically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar for randomized trials published in English from January 1990 to August 2023. The risk of bias and methodological quality assessment was performed using Cochrane's risk of bias tool embedded within the Review Manager software (RevMan 5.4.1). Moreover, this software was used to perform all the statistical analyses in the present study. During these analyses, the random effects model and 95% confidence interval was employed. The overall effect sizes for continuous and dichotomous data were calculated using the Mean Difference (MD) and Risk ratio (RR), respectively.Results: Our initial database search resulted in 4768 articles, of which only 16 were reviewed and analyzed. A subgroup analysis of data from 4 of these studies showed that hydroxyethyl starches (HES), gelatins and albumins had no significant mortality benefit compared to crystalloids (RR: 0.94; 95% CI: 0.75–1.17; P=0.58, RR: 0.71; 95% 0.46–1.08; P=0.11 and RR: 1.05; 95% CI: 0.77–1.43; P=0.77, respectively). Similarly, a subgroup analysis of data from 9 studies showed that hypertonic saline plus dextran (HSD) had no significant mortality benefit over normal saline (RR: 0.84; 95% CI: 0.62–1.13; P=0.24) or Lactated ringer's solution (RR: 1.03; 95% CI: 0.75–1.42; P=0.87). In addition, we found that hypertonic saline had a similar effect on the overall mortality as isotonic crystalloids (RR: 0.92; 95% CI: 0.68–1.25; P=0.60). Also, our analysis shows that modified fluid gelatins had a similar mortality effect as HES ((RR: 1.02; 95% CI: 0.52–2.02; P=0.95).Conclusion: Colloids, whether individually or in hypertonic crystalloids (HSD), had no mortality benefit over crystalloids in adult patients with hypovolemic shock.