Geo-economic Influence on the Effect of Fluid Volume for Sepsis Resuscitation A Meta-Analysis

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dc.contributor.authorGendreau, Segolene
dc.contributor.authorFrapard, Thomas
dc.contributor.authorCarteaux, Guillaume
dc.contributor.authorKwizera, Arthur
dc.contributor.authorAdhikari, Neill K. J.
dc.contributor.authorMer, Mervyn
dc.contributor.authorHernandez, Glenn
dc.contributor.authorDessap, Armand Mekontso
dc.date.accessioned2025-01-20T17:05:39Z
dc.date.available2025-01-20T17:05:39Z
dc.date.issued2024
dc.description.abstractRationale: Sepsis management relies on fluid resuscitation avoiding fluid overload and its related organ congestion.
dc.description.abstractObjectives: To explore the influence of country income group on risk-benefit balance of fluid management strategies in sepsis.
dc.description.abstractMethods: We searched e-databases for all randomized controlled trials on fluid resuscitation in patients with sepsis or septic shock up to January 2023, excluding studies on hypertonic fluids, colloids, and depletion-based interventions. The effect of fluid strategies (higher versus lower volumes) on mortality was analyzed per income group (i.e., low- and middle-income countries [LMICs] or high-income countries [HICs]).
dc.description.abstractMeasurements and Main Results: Twenty-nine studies (11,798 patients) were included in the meta-analysis. There was a numerically higher mortality in studies of LMICs as compared with those of HICs: median, 37% (interquartile range [IQR]: 26-41) versus 29% (IQR: 17-38; P = 0.06). Income group significantly interacted with the effect of fluid volume on mortality: Higher fluid volume was associated with higher mortality in LMICs but not in HICs: odds ratio (OR), 1.47; 95% confidence interval (95% CI): 1.14-1.90 versus 1.00 (95% CI: 0.87-1.16), P = 0.01 for subgroup differences. Higher fluid volume was associated with increased need formechanical ventilation in LMICs (OR, 1.24 [95% CI: 1.08-1.43]) but not in HICs (OR, 1.02 [95% CI: 0.80-1.29]). Self-reported access tomechanical ventilation also significantly influenced the effect of fluid volume on mortality, which increased with higher volumes only in settings with limited access to mechanical ventilation (OR: 1.45 [95% CI: 1.09-1.93] vs. 1.09 [95% CI: 0.93-1.28], P= 0.02 for subgroup differences).
dc.description.abstractConclusions: In sepsis trials, the effect of fluid resuscitation approach differed by setting, with higher volume of fluid resuscitation associated with increased mortality in LMICs and in settings with restricted access to mechanical ventilation. The precise reason for these differences is unclear and may be attributable in part to resource constraints, participant variation between trials, or other unmeasured factors.
dc.fuente.origenWOS
dc.identifier.doi10.1164/rccm.202309-1617OC
dc.identifier.eissn1535-4970
dc.identifier.issn1073-449X
dc.identifier.urihttps://doi.org/10.1164/rccm.202309-1617OC
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90739
dc.identifier.wosidWOS:001197785100015
dc.issue.numero5
dc.language.isoen
dc.pagina.final528
dc.pagina.inicio517
dc.revistaAmerican journal of respiratory and critical care medicine
dc.rightsacceso restringido
dc.subjectsepsis
dc.subjectseptic shock
dc.subjectfluid
dc.subjectresuscitation
dc.subjectmechanical ventilation
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleGeo-economic Influence on the Effect of Fluid Volume for Sepsis Resuscitation A Meta-Analysis
dc.typeartículo
dc.volumen209
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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