Comparative Effectiveness of Fluid Resuscitation Strategies for Preventing Acute Kidney Injury in Critically Ill...

Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This meta-analysis compares the effectiveness of different fluid resuscitation strategies in preventing AKI in critically ill patients. A systematic search was conducted in PubMed, MEDLINE, EMBASE, and the Cochrane database for randomized controlled trials comparing fluid resuscitation strategies in critically ill patients with AKI as an outcome. A random-effects meta-analysis was performed to calculate pooled ORs and risk ratios (RRs) with 95% CIs. Eight studies with 1,390 patients were included. There was no significant difference in AKI incidence between early goal-directed therapy (EGDT) and usual care (OR 0.90, 95% CI 0.71-1.13) or between crystalloids and colloids (OR 1.03, 95% CI 0.89-1.18). Mortality rates were similar between EGDT and usual care (RR 1.02, 95% CI 0.78-1.38) and between crystalloids and colloids (RR 1.03, 95% CI 0.93-1.14). The need for RRT did not differ significantly between strategies. Length of ICU stay was longer with EGDT than with usual care (MD 2.81 days, 95% CI 0.21-5.41), but was similar between crystalloids and colloids. This meta-analysis found no significant differences in AKI incidence, mortality, or need for RRT between fluid resuscitation strategies in critically ill patients. EGDT was associated with longer ICU stays compared to usual care. Further research is needed to optimize fluid management in critical care settings.