Liberal versus conservative fluid therapy in children and adults with sepsis or septic shock
Citation: Li D, Li X, Cui W, et al. Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock. Cochrane Database of Systematic Reviews 2018; (12): CD010593
What is this? Sepsis and septic shock are life-threatening complications of infection. Fluid therapy, either conservative or liberal, is used during its initial treatment. This may have relevance for the treatment of some critically ill patients with COVID-19.
In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials comparing liberal fluid therapy versus conservative fluid therapy for patients with sepsis or septic shock. They did not restrict their searches by date or language of publication and did these in January 2018. They identified 3 randomized trials in children (3402 participants) and were able to use data from 2 of these (3288 participants). The tested therapies varied across the trials. They found no trials in adults.
What works: Nothing noted.
What doesn’t work: Liberal fluid therapy carried a greater risk of death in children with sepsis and septic shock, and there was insufficient evidence to conclude that it had any beneficial effects on other outcomes, compared to conservative fluid therapy.
What’s uncertain: The effects of liberal versus conservative fluid therapy for adults with sepsis or septic shock are uncertain.
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