Kai Hsun Hsiao , Joseph Kalanzi , Stuart B. Watson , Srinivas Murthy , Ani Movsisyan , Kavita Kothari , Flavio Salio , Pryanka Relan
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Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08–1.09), improved creatinine levels (SMD −3.48, 95% CI −4.69 to −2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38–0.72).</p></div><div><h3>Conclusions</h3><p>Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. 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引用次数: 0
摘要
背景在大规模伤亡烧伤事件中，对重度烧伤进行及时、安全的静脉注射（IV）液体复苏可能很困难或不可能。目的 综合并评估口服/肠道液体复苏与静脉注射或不进行液体复苏治疗重度烧伤的证据确定性。方法 于 2023 年 9 月 8 日检索了 PubMed、EMBASE、CINAHL 和 Cochrane 图书馆。纳入了经两名审稿人评估符合标准的主要定量研究。对口服/肠道与静脉注射以及口服/肠道与无液体复苏的结果效应进行了 Meta 分析。采用 GRADE 对证据的确定性进行了评估。三项人类 RCT 共 100 名参与者参与了估算。与静脉输液复苏相比，口服/肠道输液复苏与死亡率风险增加（OR 1.33，95% CI 0.33-5.36）相关，但在统计学上并不显著，但证据非常不确定，而尿量无差异（SMD -0.17，95% CI -0.65-0.31），证据的确定性为中等。八项动物对照研究共 212 名参与者参与了估算。从这些动物研究来看，与静脉注射相比，肠内液体复苏可能会增加死亡率（OR 36.00，95% CI 2.72-476.28）、恶化肌酐水平（MD 22 mmol/L，95% CI 15.8-28.2）和增加尿量（MD 1 ml/kg/h，95% CI 0.55-1.45），但证据的确定性都很低。同样，在动物实验中，所有的证据都很不确定，但与不进行液体复苏相比，肠内复苏与死亡率的降低（OR 0.29，95% CI 0.08-1.结论目前比较口服/肠道和静脉输液复苏治疗重度烧伤的证据有限且不确定。然而，在无法使用静脉输液或静脉输液延迟的情况下，可以考虑口服液复苏。
Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies
Background
Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative.
Objectives
To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns.
Methods
PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE.
Results
Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33–5.36) but the evidence is very uncertain, and no difference in urine output (SMD −0.17, 95% CI −0.65–0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72–476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8–28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55–1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08–1.09), improved creatinine levels (SMD −3.48, 95% CI −4.69 to −2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38–0.72).
Conclusions
Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered.
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