Systematic review and sequential network meta‐analysis on the efficacy of periodontal regenerative therapies

et al. 2020

Crit Care

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Background Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be inferred from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. Confidence in Network Meta-Analysis (CINeMA) web application was used to rate confidence in synthetic evidence. Results Fifty-eight trials (n = 26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR 0.84; 95% CI 0.74–0.95) and L-HES (OR 0.81; 95% CI 0.69–0.95) and reduced acute kidney injury more than L-HES (OR 0.80; 95% CI 0.65–0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR 0.55; 95% CI 0.35–0.87). Conclusions Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients. Trial registration PROSPERO website, registration number: CRD42018115641).

Section: Methodsmentioning

confidence: 99%

Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses

et al. 2020

Crit Care

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“…In contrast, when the path fell within the futility area de ned by the β-spending functions (22), the two interventions showed no difference in their effects. We used the R software package "sequentialnma" to undertake sequential NMA (23). Results from these additional analyses were then compared to the results from the NMA.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Resuscitation fluid types in sepsis, surgical, and trauma patients: A Systematic review and sequential network meta-analyses

et al. 2020

Preprint

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Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced acute kidney injury more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87). Conclusions: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline did in sepsis patients; however, saline or L-HES, is better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.

“…In contrast, when the path fell within the futility area de ned by the β-spending functions (21), the two interventions showed no difference in their effects. We used the R software package "sequentialnma" to undertake sequential NMA (22). Results from these additional analyses were then compared to the results from the NMA.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Resuscitation Fluid Types in Sepsis, Surgical, and Trauma Patients: A Systematic Review and Sequential Network Meta-analyses

et al. 2020

Preprint

Self Cite

Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with serious adverse events (AEs). Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and other AEs is not comprehensive. This study aims to compare the survival benefits and AEs of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer renal AEs, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced renal AEs more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the largest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: For sepsis and surgical patients, we recommend balanced crystalloids and albumin, rather than L-HES and saline. For traumatic brain injury patients, we recommend saline or L-HES, rather than iso-oncotic albumin or balanced crystalloids. These findings could guide physicians’ fluid selection.Trial registry: PROSPERO website, registration number: CRD42018115641).