Abstract
BackgroundFluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.MethodsWe will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.DiscussionWhile fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.Systematic review registrationPROSPERO CRD42013005608. (http://www.crd.york.ac.uk/PROSPERO/)Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0150-z) contains supplementary material, which is available to authorized users.
Highlights
Fluid administration to critically ill patients remains the subject of considerable controversy
acute respiratory distress syndrome (ARDS) occurs in around 14 % of patients admitted to intensive care units (ICUs) [1] and is defined most recently by the Berlin consensus criteria [2]
systemic inflammatory response syndrome (SIRS) is a general term describing a constellation of features which are consistent with generalised inflammation and which may result from a range of insults including infection, major trauma, burns, pancreatitis and brain injury
Summary
Fluid administration to critically ill patients remains the subject of considerable controversy. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness. We have selected critical illnesses for which clear definitions exist—acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS)—since ‘critical illness’ is a poorly defined entity. Each of these terms represents a common syndrome found in critically ill patients with a range of underlying aetiologies. ARDS occurs in around 14 % of patients admitted to intensive care units (ICUs) [1] and is defined most recently by the Berlin consensus criteria [2]. By using as our study population patients with each of these syndromes, we aim to set clear boundaries for inclusion and exclusion of studies while maximising the generalisability of our findings to critically ill patients as far as possible
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