dc.contributor.author | External author(s) only | |
dc.date.accessioned | 2019-06-24T21:13:24Z | |
dc.date.available | 2019-06-24T21:13:24Z | |
dc.date.issued | 2019-05 | |
dc.identifier.citation | Seccombe, A., McCluskey, L., Moorey, H. Lasserson, D. Assessing Fluid Resuscitation in Adults with Sepsis Who Are Not Mechanically Ventilated: a Systematic Review of Diagnostic Test Accuracy Studies. J GEN INTERN MED May (2019). | en |
dc.identifier.issn | 1525-1497 | |
dc.identifier.uri | https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/231 | |
dc.description | This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. | en |
dc.description.abstract | BACKGROUND: Fluid resuscitation is a widely used intervention
that is mandated in the management of sepsis.
While its use can be life-saving, its overuse is associated
with harm. Despite this, the best means of assessing a
need for fluid resuscitation in an acute medical setting is
unclear.
OBJECTIVE: To assess studies of diagnostic tests that
identify the need for fluid resuscitation in adults with
sepsis, as defined by the presence of fluid responsiveness.
DESIGN: Protocol registration was performed in advance
(PROSPERO:CRD42017048651). Research database
searches were performed alongside additional searches
to identify grey literature. Diagnostic test accuracy studies
that assessed any fluid assessment tool were identified
independently by two authors, before data extraction and
quality assessments were performed.
PARTICIPANTS: Adults with sepsis, without intensive
care organ support, who would be appropriate for admission
to an acute medical unit.
KEY RESULTS: Of the 26,841 articles that were
screened, 14 studies were identified for inclusion, involving
a combined total of 594 patients. Five categories of
index test were identified: inferior vena cava collapsibility
index (IVCCI), haemodynamic change with passive leg
raise, haemodynamic change with respiration, haemodynamic
change with intravenous fluid administration, and
static assessment tools. Due to the high level of clinical
heterogeneity affecting all aspects of study design, quantitative
analysis was not feasible. There was a lack of
consensus on reference tests to determine fluid
responsiveness.
CONCLUSION: While fluid resuscitation is considered a
key part of themanagement of sepsis, evidence to support
fluid assessment in awake adults is lacking. This review
has highlighted a number of research recommendations
that should be addressed as amatter of urgency if patient
harm is to be avoided. | en |
dc.description.sponsorship | Supported by the NIHR. | en |
dc.description.uri | https://doi.org/10.1007/s11606-019-05073-9 | |
dc.language.iso | en | en |
dc.subject | Sepsis | en |
dc.title | Assessing Fluid Resuscitation in Adults with Sepsis Who Are Not Mechanically Ventilated: a Systematic Review of Diagnostic Test Accuracy Studies | en |
dc.type | Article | en |