Personalized fluid resuscitation may reduce mortality in septic shock as compared with fixed-volume approach - a systematic review and meta-analysis of randomized controlled trials.

Abstract

Introduction: Immediate fluid resuscitation plays a pivotal role in sepsis management. It remains unclear whether a fixed-volume or personalized strategy is more beneficial. Our aim was to compare effectiveness and safety of personalized vs. fixed-volume resuscitation in septic patients in a systematic review and meta-analysis.

Methods: We conducted a systematic literature search on PubMed, EMBASE and CENTRAL on October 30, 2024. The pre-study protocol was registered with PROSPERO (ID: CRD42024601970). Randomized controlled trials investigated septic patients who received fluid therapy in a personalized way during their initial resuscitation and reported the outcomes of our interest. The meta-analysis was performed using META packages in R with a random-effects model. Risk of bias was assessed using RoB2.

Results: The selection yielded 10 eligible randomized controlled trials (RCTs) with 1,011 patients. Data from 8 RCTs (n = 901) revealed significantly reduced odds of 30-day mortality, (OR: 0.62; 95% CI: 0.42-0.93); however, there was no significant difference in the requirement for renal replacement therapy (OR: 0.77; 95% CI: 0.23-2.55), duration of mechanical ventilation (MD: 0.27; 95% CI: -3.09-3.63), vasopressor therapy (MD: -3.70; 95% CI: -32.88-25.48) and length of hospital (MD: -0.87; 95% CI: -4.97-3.25) or intensive care unit stay (MD: 0.44; 95% CI: -1.90-2.77).

Conclusion: Personalized fluid resuscitation, compared with fixed-volume resuscitation, indicated reduced 30-day mortality in septic patients. However, the observed mortality benefit should be interpreted cautiously given the relatively small overall sample size, predominance of small single-center studies, and moderate-to-low certainty of evidence.