title: Fluid resuscitation in sepsis: a systematic review and network meta-analysis.
abstract: BACKGROUND
  Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear.
  
  
  OBJECTIVE
  To examine the effect of different resuscitative fluids on mortality in patients with sepsis.
  
  
  METHODS
  MEDLINE, EMBASE, ACP Journal Club, CINAHL, HealthSTAR, the Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials through March 2014.
  
  
  METHODS
  Randomized trials that evaluated different resuscitative fluids in adult patients with sepsis or septic shock and death. No language restrictions were applied.
  
  
  METHODS
  Two reviewers extracted data on study characteristics, methods, and outcomes. Risk of bias for individual studies and quality of evidence were assessed.
  
  
  RESULTS
  14 studies (18916 patients) were included with 15 direct comparisons. Network meta-analysis at the 4-node level showed higher mortality with starches than with crystalloids (high confidence) and lower mortality with albumin than with crystalloids (moderate confidence) or starches (moderate confidence). Network meta-analysis at the 6-node level showed lower mortality with albumin than with saline (moderate confidence) and low-molecular-weight starch (low confidence) and with balanced crystalloids than with saline (low confidence) and low- and high-molecular-weight starches (moderate confidence).
  
  
  CONCLUSIONS
  These trials were heterogeneous in case mix, fluids evaluated, duration of fluid exposure, and risk of bias. Imprecise estimates for several comparisons in this network meta-analysis contribute to low confidence in most estimates of effect.
  
  
  CONCLUSIONS
  Among patients with sepsis, resuscitation with balanced crystalloids or albumin compared with other fluids seems to be associated with reduced mortality.
  
  
  BACKGROUND
  The Hamilton Chapter of the Canadian Intensive Care Foundation and the Critical Care Medicine Residency Program and Critical Care Division Alternate Funding Plan at McMaster University.
authors.forename: Bram
authors.initials: B
authors.lastname: Rochwerg
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.forename: Anees
authors.initials: A
authors.lastname: Sindi
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Alison
authors.initials: A
authors.lastname: Fox-Robichaud
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.forename: Wojciech
authors.initials: W
authors.lastname: Szczeklik
authors.forename: Fayez
authors.initials: F
authors.lastname: Alshamsi
authors.forename: Sultan
authors.initials: S
authors.lastname: Altayyar
authors.forename: Wang-Chun
authors.initials: WC
authors.lastname: Ip
authors.forename: Guowei
authors.initials: G
authors.lastname: Li
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Anna
authors.initials: A
authors.lastname: Wludarczyk
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000418:Albumins / Q000627:therapeutic use; D003102:Colloids / Q000627:therapeutic use*; D000077324:Crystalloid Solutions; D005440:Fluid Therapy; D005780:Gelatin / Q000627:therapeutic use; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008970:Molecular Weight; D015532:Rehydration Solutions / Q000737:chemistry / Q000627:therapeutic use*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy
chemical_list: D000418:Albumins; D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D015532:Rehydration Solutions; D012462:Saline Solution, Hypertonic; D005780:Gelatin