Guidelines for the choice of intravenous fluids for vascular filling in critically ill patients, 2021 - 15/06/22
, Philippe Le Conte b, Marie-Pierre Bonnet c, d, Eric Cesareo e, Benjamin Chousterman f, g, Djamila Chaiba h, Bénédicte Douay i, Emmanuel Futier j, k, Anatole Harrois l, Catherine Huraux m, Carole Ichai n, Eric Meaudre Desgouttes o, Olivier Mimoz p, q, r, Laurent Muller s, Mathieu Oberlin t, Nicolas Peschanski u, v, Hervé Quintard w, Geoffroy Rousseau x, Dominique Savary y, Alexy Tran-Dinh z, Barbara Villoing A, Anthony Chauvin B, Emmanuel Weiss C, DAbstract |
Purpose |
To provide recommendations for the appropriate choice of fluid therapy for resuscitation of critically ill patients.
Design |
A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie et de réanimation, SFAR) and the French Society of Emergency Medicine (Société française de médecine d’urgence, SFMU) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Some recommendations were left ungraded.
Methods |
Four fields were defined: patients with sepsis or septic shock, patients with haemorrhagic shock, patients with acute brain failure, and patients during the peripartum period. For each field, the panel focused on two questions: (1) Does the use of colloids, as compared to crystalloids, reduce morbidity and mortality, and (2) Does the use of some specific crystalloids effectively reduce morbidity and mortality. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology.
Results |
The SFAR/SFMU guideline panel provided nine statements on the appropriate choice of fluid therapy for resuscitation of critically ill patients. After two rounds of rating and various amendments, strong agreement was reached for 100% of the recommendations. Out of these recommendations, two have a high level of evidence (Grade 1 +/−), six have a moderate level of evidence (Grade 2 +/−), and one is based on expert opinion. Finally, no recommendation was formulated for two questions.
Conclusions |
Substantial agreement among experts has been obtained to provide a sizable number of recommendations aimed at optimising the choice of fluid therapy for resuscitation of critically ill patients.
Le texte complet de cet article est disponible en PDF.Keywords : Fluid therapy, Sepsis or septic shock, Haemorrhagic shock, Acute brain failure, Guidelines
Plan
| ⋆ | Validated by the SFAR Clinical Guidelines Committee on the 10th of May 2021, the SFAR Board of Directors on the 19th of May 2021; the SMFU Clinical Guidelines Committee and the SFMU Board of Directors on the 29th of June 2021. |
| ⋆⋆ | Guidelines issued by the French Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie et de réanimation) in collaboration with the French Society of Emergency Medicine (Société française de médecine d’urgence). |
Vol 41 - N° 3
Article 101058- juin 2022 Retour au numéro
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