Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis.

BACKGROUND: IV fluids are recommended for adults with sepsis. However, the optimal strategy for IV fluid management in sepsis is unknown, and clinical equipoise exists. RESEARCH QUESTION: Do lower vs higher fluid volumes improve patient-important outcomes in adult patients with sepsis? STUDY DESIGN AND METHODS: We updated a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing lower vs higher IV fluid volumes in adult patients with sepsis. The coprimary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. We followed the recommendations from the Cochrane Handbook and used the Grading of Recommendations Assessment, Development and Evaluation approach. Primary conclusions were based on trials with low risk of bias if available. RESULTS: We included 13 trials (N = 4,006) with four trials (n = 3,385) added to this update. The meta-analysis of all-cause mortality in eight trials with low risk of bias showed a relative risk of 0.99 (97% CI, 0.89-1.10; moderate certainty evidence). Six trials with predefined definitions of serious adverse events showed a relative risk of 0.95 (97% CI, 0.83-1.07; low certainty evidence). Health-related quality of life was not reported. INTERPRETATION: Among adult patients with sepsis, lower IV fluid volumes probably result in little to no difference in all-cause mortality compared with higher IV fluid volumes, but the interpretation is limited by imprecision in the estimate, which does not exclude potential benefit or harm. Similarly, the evidence suggests lower IV fluid volumes result in little to no difference in serious adverse events. No trials reported on health-related quality of life. TRIAL REGISTRATION: PROSPERO; No.: CRD42022312572; URL: https://www.crd.york.ac.uk/prospero/.

Effects of magnesium, phosphate, or zinc supplementation in intensive care unit patients-A systematic review and meta-analysis.

BACKGROUND: Low-serum levels of magnesium, phosphate, and zinc are observed in many intensive care unit (ICU) patients, but clinical equipoise exists regarding supplementation strategies. We aimed to assess the desirable and undesirable effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. METHODS: We conducted a systematic review with meta-analysis of randomised clinical trials assessing the effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. Primary outcomes were mortality and duration of mechanical ventilation. We registered the protocol, followed the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, used the Cochrane risk of bias 2 tool, and the grading of recommendations, assessment, development and evaluation (GRADE) approach for assessing the certainty of the evidence. RESULTS: We identified no low risk of bias trials. For magnesium supplementation, we included three trials (n = 235); the relative risk (RR) for mortality was 0.54, 95% confidence interval (CI) 0.30-0.96 compared to no supplementation (very low certainty of evidence). For zinc supplementation, two trials were included (n = 168); the RR for mortality was 0.73, 95% CI 0.41-1.28 compared to control. No trials assessed the effects of phosphate supplementation on mortality. For outcomes other than mortality, only zero or one trial was available. CONCLUSIONS: In adult ICU patients, the certainty of evidence for the effects of supplementation with magnesium, phosphate, or zinc was very low. High-quality trials are needed to assess the value of supplementation strategies in these patients.

Lactate versus acetate buffered intravenous crystalloid solutions: a scoping review.

BACKGROUND: Buffered crystalloid solutions are increasingly recommended as first-line intravenous resuscitation fluids. However, guidelines do not distinguish between the different types of buffered solutions. The aim of this scoping review was to assess the evidence on the use of lactate- vs acetate-buffered crystalloid solutions and their potential benefits and harms. METHODS: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched PubMed, Embase, Epistemonikos, and the Cochrane Library for studies assessing the effect of lactate- vs acetate-buffered crystalloid solutions on any outcome in adult hospitalised patients. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: We included a total of 29 studies, 25 of which were clinical trials and four were observational studies. Most studies were conducted in surgical settings and indications for use were poorly described. The most commonly administered solutions were Ringer's lactate vs Ringer's acetate or Plasma-Lyte™. Outcomes included acid/base and electrolyte status; haemodynamic variables; and markers of renal and liver function, metabolism, and coagulation. Only a few studies reported patient-centred outcomes. Overall, the data provided no firm evidence for benefit or harm of either solution, and the quantity and quality of evidence were low. CONCLUSIONS: The quantity and quality of evidence on the use of different buffered crystalloid intravenous solutions were low, data were derived primarily from surgical settings, and patient-important outcomes were rarely reported; thus, the balance between benefits and harms between these solutions is largely unknown.

Lactate versus acetate buffered crystalloid solutions: Protocol for a scoping review.

BACKGROUND: Intravenous (IV) fluid therapy has become a ubiquitous intervention in everyday clinical practice. Several types of fluid are available including isotonic crystalloid fluids. Among crystalloid fluids, buffered solutions (derivatives of the original Hartmann's and Ringer's solutions) are increasingly recommended as first-line resuscitation fluids. However, the choice between different buffered solutions appears to be difficult with limited data to support the use of lactate vs. acetate buffered solutions. Accordingly, we aim at systematically describing the body of evidence on the use of the different types of buffered crystalloid solutions in hospitalised patients. METHODS: We will conduct a scoping review of all study designs (i.e. no study design will per se be excluded from the proposed review) in accordance with the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) statement. RESULTS: We will provide descriptive analysis of the included studies/trials, i.e. no meta-analyses will be conducted. We will include studies on adult hospitalised patients receiving IV fluid for any reason. Studies must compare any crystalloid solution primarily buffered with lactate versus any primarily acetate buffered solution. All outcome measures will be reported. The quality of evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. CONCLUSION: This outlined scoping review will provide a summary of the current body of evidence on the use, effects and side-effects of buffered crystalloid solutions. This will provide an important update of the current evidence on the use, of "buffered" crystalloid solutions including evidence of potential benefits and harms.

Coffee consumption and work satisfaction among Scandinavian anaesthesiologists: A survey.

BACKGROUND: It is a common prejudice that anaesthetic doctors are believed to have high coffee consumption. In this study, we aimed to assess the association between coffee drinking and work satisfaction among Scandinavian anaesthesiologists. We hypothesised that coffee consumption was positively correlated with work satisfaction. METHODS: We invited anaesthesiologists attending the 34th congress of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine in Malmö, Sweden, September 2017 to participate in a paper-based survey. We collected data on characteristics of the respondents, coffee drinking and work satisfaction, and compared coffee vs non-coffee drinkers with regard to work satisfaction scored on a modified Wong-Baker Faces Pain Rating Scale (Visual Analogue Scale from 0 to 10). RESULTS: A total of 271 anaesthesiologists participated in the survey, of which 265 (97.7%) of the questionnaires contained valid data. Some 143 (54.0%) of the respondents were women, the median (interquartile range, IQR) age was 41.0 (35.0-49.5) years, and 242 (91.3%) were coffee drinkers. Coffee drinkers consumed median 4.0 (IQR: 2.5-5.0) cups of coffee daily. Overall work satisfaction was median 8 (IQR: 8-9), with no difference between respondents drinking coffee and those who did not (median 8 (IQR: 8-9) vs 8 (IQR: 8-9), Wilcoxon rank sum test, P = 0.62). Also, we found no association between work satisfaction and the number of cups of coffee consumed daily (r2  = 0.005, P = 0.24). CONCLUSION: In this survey, we found high work satisfaction among Scandinavian anaesthesiologists, with no difference between coffee and non-coffee drinkers.