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...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-11-01
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| Series: | Burns Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S246891222400052X |
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| author | Kai Hsun Hsiao Joseph Kalanzi Stuart B. Watson Srinivas Murthy Ani Movsisyan Kavita Kothari Flavio Salio Pryanka Relan |
| author_facet | Kai Hsun Hsiao Joseph Kalanzi Stuart B. Watson Srinivas Murthy Ani Movsisyan Kavita Kothari Flavio Salio Pryanka Relan |
| author_sort | Kai Hsun Hsiao |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-f643cdc3b14343c793ee0fb6679ef771 |
| institution | Kabale University |
| issn | 2468-9122 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Burns Open |
| spelling | doaj-art-f643cdc3b14343c793ee0fb6679ef7712024-11-13T04:30:13ZengElsevierBurns Open2468-91222024-11-0184100364Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studiesKai Hsun Hsiao0Joseph Kalanzi1Stuart B. Watson2Srinivas Murthy3Ani Movsisyan4Kavita Kothari5Flavio Salio6Pryanka Relan7Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, Switzerland; Corresponding author at: Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Avenue Appia 20, CH-1211 Geneva, Switzerland.Department of Anaesthesia, Critical Care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, UgandaCanniesburn Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow, United KingdomFaculty of Medicine, University of British Columbia, Vancouver, CanadaConsultant to the Methods and Standards Team, World Health Organization, Geneva, SwitzerlandConsultant to Library and Digital Information Networks, World Health Organization, Geneva, SwitzerlandEmergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, SwitzerlandEmergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, SwitzerlandBackground: 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.http://www.sciencedirect.com/science/article/pii/S246891222400052XBurnsFluid therapyIntravenous fluidMass casualty incidentsOral fluidOral rehydration solution |
| spellingShingle | Kai Hsun Hsiao Joseph Kalanzi Stuart B. Watson Srinivas Murthy Ani Movsisyan Kavita Kothari Flavio Salio Pryanka Relan Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies Burns Open Burns Fluid therapy Intravenous fluid Mass casualty incidents Oral fluid Oral rehydration solution |
| title | Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies |
| title_full | Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies |
| title_fullStr | Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies |
| title_full_unstemmed | Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies |
| title_short | Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies |
| title_sort | oral enteral fluid resuscitation in the initial management of major burns a systematic review and meta analysis of human and animal studies |
| topic | Burns Fluid therapy Intravenous fluid Mass casualty incidents Oral fluid Oral rehydration solution |
| url | http://www.sciencedirect.com/science/article/pii/S246891222400052X |
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