Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
Abstract Background Fluid overload is a risk factor for organ dysfunction and death in intensive care unit (ICU) patients, but no guidelines exist for its management. We systematically reviewed benefits and harms of a single loop diuretic, the predominant treatment used for fluid overload in these p...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-06-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-022-01024-6 |
| _version_ | 1828813018726662144 |
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| author | Sine Wichmann Marija Barbateskovic Ning Liang Theis Skovsgaard Itenov Rasmus Ehrenfried Berthelsen Jane Lindschou Anders Perner Christian Gluud Morten Heiberg Bestle |
| author_facet | Sine Wichmann Marija Barbateskovic Ning Liang Theis Skovsgaard Itenov Rasmus Ehrenfried Berthelsen Jane Lindschou Anders Perner Christian Gluud Morten Heiberg Bestle |
| author_sort | Sine Wichmann |
| collection | DOAJ |
| description | Abstract Background Fluid overload is a risk factor for organ dysfunction and death in intensive care unit (ICU) patients, but no guidelines exist for its management. We systematically reviewed benefits and harms of a single loop diuretic, the predominant treatment used for fluid overload in these patients. Methods We conducted a systematic review with meta-analysis and Trial Sequential Analysis (TSA) of a single loop diuretic vs. other interventions reported in randomised clinical trials, adhering to our published protocol, the Cochrane Handbook, and PRISMA statement. We assessed the risks of bias with the ROB2-tool and certainty of evidence with GRADE. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020184799). Results We included 10 trials (804 participants), all at overall high risk of bias. For loop diuretics vs. placebo/no intervention, we found no difference in all-cause mortality (relative risk (RR) 0.72, 95% confidence interval (CI) 0.49–1.06; 4 trials; 359 participants; I 2 = 0%; TSA-adjusted CI 0.15–3.48; very low certainty of evidence). Fewer serious adverse events were registered in the group treated with loop diuretics (RR 0.81, 95% CI 0.66–0.99; 6 trials; 476 participants; I 2 = 0%; very low certainty of evidence), though contested by TSA (TSA-adjusted CI 0.55–1.20). Conclusions The evidence is very uncertain about the effect of loop diuretics on mortality and serious adverse events in adult ICU patients with fluid overload. Loop diuretics may reduce the occurrence of these outcomes, but large randomised placebo-controlled trials at low risk of bias are needed. |
| first_indexed | 2024-12-12T09:53:11Z |
| format | Article |
| id | doaj.art-9a5285705d674876b497f2d47206a225 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-12T09:53:11Z |
| publishDate | 2022-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-9a5285705d674876b497f2d47206a2252022-12-22T00:28:13ZengSpringerOpenAnnals of Intensive Care2110-58202022-06-0112111610.1186/s13613-022-01024-6Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysisSine Wichmann0Marija Barbateskovic1Ning Liang2Theis Skovsgaard Itenov3Rasmus Ehrenfried Berthelsen4Jane Lindschou5Anders Perner6Christian Gluud7Morten Heiberg Bestle8Department of Anaesthesiology, Copenhagen University Hospital − North ZealandCopenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital—RigshospitaletInstitute of Basic Research in Clinical Medicine, China Academy of Chinese Medical SciencesDepartment of Anaesthesiology, Copenhagen University Hospital − North ZealandDepartment of Anaesthesiology, Copenhagen University Hospital − North ZealandCopenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital—RigshospitaletDepartment of Intensive Care, Copenhagen University Hospital − RigshospitaletCopenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital—RigshospitaletDepartment of Anaesthesiology, Copenhagen University Hospital − North ZealandAbstract Background Fluid overload is a risk factor for organ dysfunction and death in intensive care unit (ICU) patients, but no guidelines exist for its management. We systematically reviewed benefits and harms of a single loop diuretic, the predominant treatment used for fluid overload in these patients. Methods We conducted a systematic review with meta-analysis and Trial Sequential Analysis (TSA) of a single loop diuretic vs. other interventions reported in randomised clinical trials, adhering to our published protocol, the Cochrane Handbook, and PRISMA statement. We assessed the risks of bias with the ROB2-tool and certainty of evidence with GRADE. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020184799). Results We included 10 trials (804 participants), all at overall high risk of bias. For loop diuretics vs. placebo/no intervention, we found no difference in all-cause mortality (relative risk (RR) 0.72, 95% confidence interval (CI) 0.49–1.06; 4 trials; 359 participants; I 2 = 0%; TSA-adjusted CI 0.15–3.48; very low certainty of evidence). Fewer serious adverse events were registered in the group treated with loop diuretics (RR 0.81, 95% CI 0.66–0.99; 6 trials; 476 participants; I 2 = 0%; very low certainty of evidence), though contested by TSA (TSA-adjusted CI 0.55–1.20). Conclusions The evidence is very uncertain about the effect of loop diuretics on mortality and serious adverse events in adult ICU patients with fluid overload. Loop diuretics may reduce the occurrence of these outcomes, but large randomised placebo-controlled trials at low risk of bias are needed.https://doi.org/10.1186/s13613-022-01024-6Critical careDiureticsFluid accumulationFluid overloadFurosemideLoop diuretics |
| spellingShingle | Sine Wichmann Marija Barbateskovic Ning Liang Theis Skovsgaard Itenov Rasmus Ehrenfried Berthelsen Jane Lindschou Anders Perner Christian Gluud Morten Heiberg Bestle Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis Annals of Intensive Care Critical care Diuretics Fluid accumulation Fluid overload Furosemide Loop diuretics |
| title | Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis |
| title_full | Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis |
| title_fullStr | Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis |
| title_full_unstemmed | Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis |
| title_short | Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis |
| title_sort | loop diuretics in adult intensive care patients with fluid overload a systematic review of randomised clinical trials with meta analysis and trial sequential analysis |
| topic | Critical care Diuretics Fluid accumulation Fluid overload Furosemide Loop diuretics |
| url | https://doi.org/10.1186/s13613-022-01024-6 |
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