Harms and Benefits of Subcutaneous Hydration in Older Patients: Systematic Review and Meta‐Analysis

Abstract

OBJECTIVE To review all available original publications on the harms and benefits of subcutaneous (SC) hydration in older patients. DESIGN Systematic review and meta‐analysis. PARTICIPANTS All studies on SC hydration in older patients without restrictions on design or language. MEASUREMENTS The Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science databases and trial registries were searched from inception to November 5, 2019, and two reviewers independently extracted the data and assessed the risk of bias of individual outcomes. RESULTS Thirty‐one publications from 29 studies met the eligibility criteria. The data from six randomized controlled trials were used for the meta‐analyses. The subgroup analysis including only the studies with the lowest risk of bias showed that SC hydration was associated with fewer adverse effects than intravenous (IV) hydration (risk ratio (RR) = 0.69; 95% confidence interval (CI) = 0.53–0.88; P = .003; n = 4; I2 = 0.0%; 545 infusions in each group). In absolute numbers, patients treated with SC hydration had an incidence rate of 90 adverse effects per 1,000 infusions versus 130 adverse effects per 1,000 infusions (95% CI = 102–169) with IV hydration. Secondary outcomes comparing IV with SC hydration showed that SC was 3.2 minutes faster to set up and markedly reduced the risk of agitation (RR = 0.42; 95% CI = 0.22–0.79; P = .007; I2 = 65%; n = 3); however, SC hydration delivered a lower volume of fluid and was less efficient at reducing serum osmolality (s‐osmolality). CONCLUSIONS SC hydration is safer than IV hydration and potentially reduces the risk of agitation, but it is less effective. SC hydration should be available as an alternative to IV hydration when treating older patients for mild‐to‐moderate dehydration. More high‐quality studies are needed in the field to increase the confidence in the estimates.

Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study

“…Recent literature has shown hypodermoclysis to be safe or equivalent to IV hydration in older adults, 9 or lower than in patients treated with IV infusions. 20 Similar to our study, one review found local oedema to be the most common toxicity. 20 Our study found 38.7% of patients to experience some form of ‘harm’ whilst on hypodermoclysis infusions, but it is important to note that our study included a broad range of adverse events as harms, ranging in type and severity.…”

“…20 Similar to our study, one review found local oedema to be the most common toxicity. 20 Our study found 38.7% of patients to experience some form of 'harm' whilst on hypodermoclysis infusions, but it is important to note that our study included a broad range of adverse events as harms, ranging in type and severity. The collection of a broader range of harms is important, as these may impact the persons symptom burden and also the practical ability to deliver the infusion; and hence may influence the volume, rate or site of ongoing hypodermoclysis, or may influence cessation of therapy.…”

“…Serious adverse events were not captured in one review, 1 but reviews in older adults found serious adverse events to be rare with an occurrence of 0.003 episodes per day of therapy 9 or at an incidence rate of 2.2 adverse effects per 1000 infusions. 20 Though infrequent, these toxicities would still require further invasive interventions, or in the case of grade 4 urinary retention in one patient in our study, can be life threatening. Our study did not compare hypodermoclysis against other forms of infusion, and further studies could investigate harms against patients receiving hydration through other methods in order to form a clearer picture of the safety profile of hypodermoclysis.…”

Absorption rate of subcutaneously infused fluid in ill multimorbid older patients

“…The capacity to provide informed consent was evaluated by the patient’s physician and the study physician. This is in accordance with the ethical approval, which unfortunately excludes the delirious patient, in which SC hydration might be especially suitable [ 3 ]. Exclusion criteria were: fluid restriction, risk of acute deterioration of illness, and very short life expectancy.…”

“…Dehydration is a herald of death [ 1 , 2 ], and adequate fluid therapy is an important aspect of treating the older adult. Subcutaneous (SC) hydration is a safe and easy-to-apply method for parenteral fluid therapy recommended to treat mild dehydration and patients at risk of dehydration [ 3 – 5 ]. Previous studies have examined the absorption of SC hydration using radioisotopes to track fluid movement in younger adults [ 6 ] and healthy adults over 65 years [ 7 , 8 ].…”