Abstract：
This study aimed to evaluate the current evidence on various aspects of fluid therapy such as type, volume, and timing of fluid bolus administration in children with septic shock. Systematic review and meta-analysis of clinical trials including children less than 18 years of age admitted to the pediatric emergency and intensive care unit with severe infection and shock requiring fluid resuscitation. The intervention included balanced crystalloids (BC) vs normal saline (NS), colloids vs NS, restricted vs liberal fluid bolus, and slow vs fast fluid bolus. The primary outcome was mortality rate. Of the 219 citations retrieved, 12 trials (3526 children with severe infection with or without malaria and shock) were included. The pooled results found no significant difference in the mortality rate between groups comparing balanced crystalloids (BC) vs normal saline (NS), colloids vs NS, restricted vs liberal fluid bolus, and slow vs fast fluid bolus. The risk of acute kidney injury (AKI) was significantly less in the BC group compared to the NS group. The certainty of evidence for mortality was of \"moderate certainty\" in the BC vs NS group, and was of \"very low certainty\" for the other two groups.
CONCLUSIONS: The current meta-analysis found no significant difference in the mortality rate between the types of resuscitation fluid, and their speed or volume of administration. However, a significantly decreased risk of AKI was found in the BC group. More evidence is needed regarding the speed and volume of administration of fluid boluses in critically ill children.Prospero registration: CRD42020209066.
BACKGROUND: • Balanced crystalloids (BC) may be better than normal saline (NS) for fluid resuscitation in critically ill children.
BACKGROUND: • BC are better than NS for fluid resuscitation in critically ill children as they decrease AKI and hyperchloremia.
CONCLUSIONS: The current meta-analysis found no significant difference in the mortality rate between the types of resuscitation fluid, and their speed or volume of administration. However, a significantly decreased risk of AKI was found in the BC group. More evidence is needed regarding the speed and volume of administration of fluid boluses in critically ill children.Prospero registration: CRD42020209066.
BACKGROUND: • Balanced crystalloids (BC) may be better than normal saline (NS) for fluid resuscitation in critically ill children.
BACKGROUND: • BC are better than NS for fluid resuscitation in critically ill children as they decrease AKI and hyperchloremia.
摘要：
这项研究旨在评估目前在液体治疗的各个方面的证据，如类型，volume,以及感染性休克儿童的液体推注给药时间。临床试验的系统评价和荟萃分析，包括儿科急诊和重症监护病房收治的18岁以下儿童，患有严重感染和休克，需要液体复苏。干预包括平衡晶体（BC）与生理盐水（NS），胶体与NS,受限与自由流体推注，缓慢和快速流体推注。主要结果是死亡率。在检索到的219篇引文中，纳入12项试验（3526例严重感染伴或不伴疟疾和休克的儿童）。合并的结果发现，比较平衡晶体（BC）与生理盐水（NS）的组之间的死亡率没有显着差异，胶体与NS,受限与自由流体推注，缓慢和快速流体推注。与NS组相比，BC组发生急性肾损伤（AKI）的风险明显较低。在BC与NS组中，死亡证据的确定性为“中度确定性”，对于其他两组来说，“确定性非常低”。
结论：当前的荟萃分析发现，复苏液类型之间的死亡率没有显着差异，以及他们的管理速度或数量。然而,BC组AKI风险显著降低.需要更多的证据来证明危重病儿童的给药速度和剂量。Prospero注册：CRD42020209066。
背景：•对于危重患儿的液体复苏，平衡晶体（BC）可能优于生理盐水（NS）。
背景：•在危重患儿的液体复苏中，BC优于NS，因为它们可以减少AKI和高氯血症。
结论：当前的荟萃分析发现，复苏液类型之间的死亡率没有显着差异，以及他们的管理速度或数量。然而,BC组AKI风险显著降低.需要更多的证据来证明危重病儿童的给药速度和剂量。Prospero注册：CRD42020209066。
背景：•对于危重患儿的液体复苏，平衡晶体（BC）可能优于生理盐水（NS）。
背景：•在危重患儿的液体复苏中，BC优于NS，因为它们可以减少AKI和高氯血症。
