Conservative compared to liberal fluid management for ARDS
| Patient or population: adults with ARDS Settings: intensive care Intervention: conservative fluid strategy Comparison: liberal fluid strategy | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Liberal fluid strategy | Conservative fluid strategy | |||||
| Mortality (pooled up to 60 days) | 311 per 1000 | 283 per 1000 (239 to 332) | RR 0.91 (0.77 to 1.07) | 1206 (five RCTs) | ++-- LOW Due to serious indirectness and serious imprecision | Variable fluid strategies, fluid balance achieved and outcome reporting |
| Adverse event: AKI | 1000 (one study) | +++- MODERATE Due to serious imprecision | Single study. There were a similar number of renal failure free days between conservative and liberal fluid management groups. In a posthoc analysis where creatinine was adjusted for fluid balance, conservative fluid management was associated with lower incidence of AKI (58% vs 66%). | |||
| Adverse event: RRT | 141 per 1000 | 100 per 1000 (70 to 139) | RR 0.71 (0.50 to 0.99) | 1000 (one study) | +++- MODERATE Due to serious imprecision | Single study |
AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; RRT, renal replacement therapy.