Fluid volume, fluid balance and patient outcome in severe sepsis and septic shock: A systematic review

Purpose: This systematic review and meta-analysis was conducted to evaluate the mortality risk in severe sepsis and septic shock with a low and high fluid volume/balance. Methods: Cohort studies that compared the mortality of patients with low or high fluid volume/balance were included. Electronic databases: PubMed/Medline PLUS, Embase, Scopus, and Web of Science were searched. Patient mortality at the longest follow-up was the primary outcome measure. The data were analyzed using STATA 14 statistical software. Results: The current study included fifteen studies with 31,443 severe sepsis and/or septic shock patients. Patients with a high fluid balance have a 70% increased risk of mortality (pooled RR: 1.70; CI: 1.20, 2.41; P = .003). Survivors of severe sepsis and/or septic shock received higher fluid volume in the first three hours. However, fluid volume administered in the first 24 h was higher for non-survivors. Low volume resuscitation in the first 24 h had a significant mortality reduction (P = .02). Conclusion: High fluid balance from the first 24 h to ICU discharge increases the risk of mortality in severe sepsis and/or septic shock. However, randomized clinical trials should be conducted to resolve the dilemma of fluid resuscitation. (C) 2018 Published by Elsevier Inc.