Fluid resuscitation management in patients with sepsis and septic shock: a network meta-analysis

Fluid resuscitation is a cornerstone intervention for patients with sepsis. This network meta-analysis aimed to compare various fluid resuscitation strategies on complications, treatment responses, and outcomes in patients with sepsis or septic shock.

PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science were comprehensively searched for records available up to September 2024. Studies were screened and data were extracted based on preset inclusion and exclusion criteria. The quality of studies was evaluated via the Risk of Bias 2 tool. Data analyses were done in Stata18 MP and R 4.4.1.

28 randomized controlled trials were recruited, encompassing 8770 patients. Balanced crystalloids (BC) demonstrated superior efficacy over low molecular weight hydroxyethyl starch (L-HES) (RR -0.84; 95 % CrI [0.75, 0.95]) and saline (RR -0.89; 95 % CrI [0.81, 0.97]) in reducing 90-day mortality. In terms of complications, BC was linked with a reduced need for renal replacement therapy (RRT) (RR -0.59; 95 % CrI [0.3, 0.99]) compared to high molecular weight hydroxyethyl starch (H-HES). BC ranked highest in reducing 28-day mortality (SUCRA = 71.4 %), demand for RRT (SUCRA = 75.5 %), blood transfusion (BT) (SUCRA = 72.2 %), and 90-day mortality (SUCRA = 86.3 %). Hyperoncotic albumin (Hyper-Alb) was most effective in reducing the incidence of acute kidney injury (AKI) (SUCRA = 74.5 %).

BC holds significant clinical potential for fluid resuscitation in patients with sepsis and septic shock. It outperforms both L-HES and saline in reducing mortality among these patients, while Hyper-Alb is most effective in mitigating renal injury.