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Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis.
- Source :
-
Critical Care Medicine . Nov2021, Vol. 49 Issue 11, pe1163-e1175. 13p. - Publication Year :
- 2021
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Abstract
- <bold>Objectives: </bold>To evaluate the efficacy of the simultaneous hypertonic saline solution and IV furosemide (HSS+Fx) for patients with fluid overload compared with IV furosemide alone (Fx).<bold>Data Sources: </bold>Electronic databases (MEDLINE, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, and WOS) were searched from inception to March 2020.<bold>Study Selection: </bold>Randomized controlled trials on the use of HSS+Fx in adult patients with fluid overload versus Fx were included.<bold>Data Extraction: </bold>Data were collected on all-cause mortality, hospital length of stay, heart failure-related readmission, along with inpatient weight loss, change of daily diuresis, serum creatinine, and 24-hour urine sodium excretion from prior to post intervention. Pooled analysis with random effects models yielded relative risk or mean difference with 95% CIs.<bold>Data Synthesis: </bold>Eleven randomized controlled trials comprising 2,987 acute decompensated heart failure patients were included. Meta-analysis demonstrated that HSS+Fx was associated with lower all-cause mortality (relative risk, 0.55; 95% CI, 0.46-0.67; p < 0.05; I2 = 12%) and heart failure-related readmissions (relative risk, 0.50; 95% CI, 0.33-0.76; p < 0.05; I2 = 61%), shorter hospital length of stay (mean difference, -3.28 d; 95% CI, -4.14 to -2.43; p < 0.05; I2 = 93%), increased daily diuresis (mean difference, 583.87 mL; 95% CI, 504.92-662.81; p < 0.05; I2 = 76%), weight loss (mean difference, -1.76 kg; 95% CI, -2.52 to -1.00; p < 0.05; I2 = 57%), serum sodium change (mean difference, 6.89 mEq/L; 95% CI, 4.98-8.79; p < 0.05; I2 = 95%), and higher 24-hour urine sodium excretion (mean difference, 61.10 mEq; 95% CI, 51.47-70.73; p < 0.05; I2 = 95%), along with decreased serum creatinine (mean difference, -0.46 mg/dL; 95% CI, -0.51 to -0.41; p < 0.05; I2 = 89%) when compared with Fx. The Grading of Recommendation, Assessment, Development, and Evaluation certainty of evidence ranged from low to moderate.<bold>Conclusions: </bold>Benefits of the HSS+Fx over Fx were observed across all examined outcomes in acute decompensated heart failure patients with fluid overload. There is at least moderate certainty that HSS+Fx is associated with a reduction in mortality in patients with acute decompensated heart failure. Factors associated with a successful HSS+Fx utilization are still unknown. Current evidence cannot be extrapolated to other than fluid overload states in acute decompensated heart failure. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HYPERTONIC saline solutions
*HEART failure
*HEART failure patients
*RANDOM effects model
*LENGTH of stay in hospitals
*FUROSEMIDE
*DIURETICS
*RESEARCH
*CLINICAL trials
*META-analysis
*RESEARCH methodology
*SYSTEMATIC reviews
*WATER-electrolyte imbalances
*MEDICAL cooperation
*EVALUATION research
*DRUG administration
*COMPARATIVE studies
*DOSE-effect relationship in pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 00903493
- Volume :
- 49
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Critical Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 152967768
- Full Text :
- https://doi.org/10.1097/CCM.0000000000005174