Table 1.
Main characteristics of the included studies *: the abstracts published by Vasudevan and Reddy et al. refer to the same RCT, hence the total number of patients analyzed is 557. Abbreviations: LR: lactated Ringer’s solution; NS: normal saline; SD: standard deviation; IQR: interquartile range; SIRS: systemic inflammatory response syndrome; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; PCT: procalcitonin; LoH: length of hospitalization; OF: organ failure; HCO3: bicarbonate; ICU: need for intensive care; BUN: blood urea nitrogen; IL-6: interleukin-6.
| Author, Year | Country | Data Source | Recruitment Period | Sample Size LR/NS |
Age Mean ± SD/Median (IQR) |
Males (%) | Baseline SIRS n (%) |
Fluid Administration Protocol | Reported Outcomes |
|---|---|---|---|---|---|---|---|---|---|
| Choosakul, 2018 [43] |
Thailand | full text | Nov 2015– Dec 2016 |
23/24 | LR: 54.8 ± 20.4 NS: 48.3 ± 13.6 |
LR: 71 NS: 52 |
LR: 8 (35) NS: 10 (42) |
Goal-directed; 20 mL/kg for 30 min, followed by 3 mL/kg/h; BUN controlled | SIRS, CRP, ESR, PCT, LoH, local compl., OF, mortality, severity, fluid infused 24h |
| de-Madaria, 2017 [44] |
Spain | full text | Feb 2013– Mar 2015 |
19/21 | LR: 63.8 ± 19.1 NS: 61.4 ± 15.5 |
LR: 52 NS: 42 |
LR: 9 (47) NS: 14 (67) |
Goal-directed; 1000 mL 10% dextrose; 15 mL/kg for 60 min and 1.2 mL/kg/h or 10 mL/kg for 60 min and 1 mL/kg/h | SIRS, CRP, HCO3, pH, local compl., OF, severity, mortality, LoH, ICU, fluid infused 24h, nutritional support, invasive treatment |
| Farrell, 2018 [47] |
USA | abstract | no data | 38/38 | LR: 12.1 ± 4.5 NS: 12.3 ± 5.3 |
LR: 43 NS: 50 |
LR: 6 (16) NS: 7 (18) |
1.5 times maintenance fluid | SIRS, CRP, BUN, LoH, severity, local compl., time to full feeds |
| Karki, 2022 [30] |
Nepal | full text | Oct 2018– Jun 2019 |
26/25 | 41.33 ± 14.17 | LR: 96 NS: 4 |
LR: 12 (46) NS: 14 (64) |
1000 mL 5% dextrose; 10 mL/kg for 1.5 mL/kg/h | SIRS, CRP, local compl., LoH, mortality, severity |
| Kayhan, 2021 [31] | Turkey | full text | Jan 2019– Sep 2019 |
67/65 | LR: 54.6 ± 17.9 NS: 56.3 ± 17.2 |
LR: 52 NS: 48 |
NA | Goal-directed; 1000 mL in the first 60 min; 3 mL/kg/h | CRP, pH, HCO3, local compl., OF, severity, LoH |
| Lee, 2020 [45] |
USA | full text | Sep 2018– Aug 2019 |
61/60 | LR: 42.3 ± 14.0 NS: 43.5 ± 14.2 |
LR: 55 NS: 49 |
NA | 10 mL/kg bolus; 3 mL/kg/h | SIRS, LoH, ICU, local compl., OF, severity, mortality, hyperchloremia, recurrence, need for intervention, fluid infused 24h, fluid before randomization |
| Reddy *, 2014 [42] |
India | abstract | Jul 2012– Jun 2013 |
25/25 | 45.8 ± 16.5 | 56 | NA | Goal-directed; 20 mL/kg bolus, individualized maintenance fluid | LoH, severity, IL-6, need for intervention, infective compl., OF, fluid infused 7 days |
| Vasudevan *, 2013 [46] |
India | abstract | Jan 2012– Jun 2013 |
25/25 | mean: 41.64 | 66 | NA | Goal-directed; 20 mL/kg bolus, 3–5 mL/kg/h | LoH, local compl., ICU, OF, infective compl., need for intervention |
| Wu, 2011 [17] |
USA | full text | May 2009– Feb 2010 |
19/21 | LR: 50 (40–73) NS: 54 (40–60) |
LR: 44 NS: 68 |
LR: 6 (32) NS: 4 (19) |
Goal-directed and standard subgroups; 20 mL/kg bolus for 30 min, 3 mL/kg/h for 8–12 h, after either 20 mL/kg bolus and 3 mL/kg/h or no bolus and 1.5 mL/kg/h | SIRS, CRP, local compl., LoH, ICU, OF, mortality, infection, fluid before randomization |