• Tine Sylvest Meyhoff, Møller Morten Hylander MH Department of Intensive Care, Copenhagen, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark., Peter Buhl Hjortrup, Maria Cronhjort, Anders Perner, and Jørn Wetterslev.
• Department of Intensive Care, Copenhagen, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark. Electronic address: tine.sylvest.meyhoff@regionh.dk.
• Chest. 2020 Jun 1; 157 (6): 1478-1496.

ObjectiveIV fluids are recommended during the initial management of sepsis, but the quality of evidence is low, and clinical equipoise exists. We aimed to assess patient-important benefits and harms of lower vs higher fluid volumes in adult patients with sepsis.MethodsWe conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials of IV fluid volume separation in adult patients with sepsis. We adhered to our published protocol; the Cochrane handbook; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and the Grading of Recommendations Assessment, Development and Evaluation statements. The primary outcomes were all-cause mortality, serious adverse events (SAEs), and quality of life.ResultsWe included nine trials (n = 637); all were published after 2015 and had an overall high risk of bias. We found no statistically significant difference between lower vs higher fluid volumes in all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.69-1.10; I2 = 0%; TSA-adjusted CI, 0.34-2.22) or SAEs (RR, 0.91; 95% CI, 0.78-1.05; I2 = 0%; TSA-adjusted CI, 0.68-1.21). No trials reported on quality of life. We did not find differences in the secondary or exploratory outcomes. The quality of evidence was very low across all outcomes.ConclusionsIn this systematic review, we found very low quantity and quality of evidence supporting the decision on the volumes of IV fluid therapy in adults with sepsis.Trial RegistryClinicalTrials.gov; No.: NCT03668236; URL: www.clinicaltrials.gov.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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