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Cochrane Database of Systematic Reviews

Apports liquidiens pour la méningite bactérienne aiguë

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Información

DOI:
https://doi.org/10.1002/14651858.CD004786.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 05 mayo 2014see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Infecciones respiratorias agudas

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Ian K Maconochie

    Correspondencia a: Department of Paediatrics A&E, St Mary's Hospital, London, UK

    [email protected]

  • Soumyadeep Bhaumik

    South Asian Cochrane Network & Centre, Prof. BV Moses Centre for Research & Training in Evidence‐Informed Health Care & Health Policy, Christian Medical College, Vellore, India

Contributions of authors

Ian Maconochie (IM) jointly (with Richmal Oates‐Whitehead (ROW)) conceptualised the review; commented on drafts of the protocol and was involved in selecting trials for inclusion in the review; performed independent data extraction and quality assessment of the included trials; used the GRADE approach to interpret the study findings and commented on all drafts of the review including this update.

Soumyadeep Bhaumik (SB) led this 2014 update and performed independent selection of trials for inclusion in the review, worked on the manuscript of the review and also used the GRADE approach to interpret the findings of the study.

Sources of support

Internal sources

  • Royal College of Paediatrics and Child Health, UK.

  • Christian Medical College, Vellore, India.

    Logistic support for Soumyadeep Bhaumik . Hosts the Prof. B V Moses Centre for Research & Training in Evidence‐Informed Healthcare and Health Policy

External sources

  • Department for International Development (DFID), UK.

    Project funding for the Effective Healthcare Research Consortium; salary for Soumyadeep Bhaumik

Declarations of interest

Ian Maconochie ‐ no known conflicts of interest to declare.
Soumyadeep Bhaumik ‐ no known conflicts of interest to declare.

Acknowledgements

The review authors would like to acknowledge the major contribution of the late Richmal Oates‐Whitehead. She was the person who turned the idea of this review into a reality by doing much of the work for the first published version (Oates‐Whitehead 2005). Richmal died suddenly and was not therefore able to contribute to this version. She jointly (with IM) conceptualised the review, took the lead in writing the protocol and overall review, performed initial searches of databases for trials, was involved in selecting trials for inclusion, and performed independent data extraction and quality assessment of the included trials. The late Richmal is not included as an author on this update although she was the original contact reviewer in the first published version in 2005. Richmal died after the publication of that version.

Morwenna Stewart (MS) was an author on the original review and the 2008 update. Morwenna performed independent data extraction and quality assessment of the included trials, and commented on all drafts of the review.

Harry Baumer (HB) commented on drafts of the protocol and was involved in selecting trials for inclusion in the review; performed independent data extraction and quality assessment of the included trials; and commented on all drafts of the review. HB led the previous update.

The review authors would like to thank Dr Keith Powell and Dr Sunit Singhi for taking time to reply to requests for further information on their respective studies; Liz Dooley, Managing Editor of the Cochrane Acute Respiratory Infections (ARI) Group, Sarah Thorning, Trials Search Co‐ordinator of the ARI Group, Carol Wical and Ruth Foxlee, former members of the ARI Group editorial team, for their help and support. Finally, we would like to thank the following people for commenting on the 2008 update: Hayley Edmonds, Robert Heyderman, Sree Nair and George Swingler.

Version history

Published

Title

Stage

Authors

Version

2016 Nov 04

Fluid therapy for acute bacterial meningitis

Review

Ian K Maconochie, Soumyadeep Bhaumik

https://doi.org/10.1002/14651858.CD004786.pub5

2014 May 05

Fluid therapy for acute bacterial meningitis

Review

Ian K Maconochie, Soumyadeep Bhaumik

https://doi.org/10.1002/14651858.CD004786.pub4

2008 Jan 23

Fluid therapy for acute bacterial meningitis

Review

Ian K Maconochie, J Harry Baumer

https://doi.org/10.1002/14651858.CD004786.pub3

2005 Jul 20

Fluid therapy for acute bacterial meningitis

Review

Richmal M Oates‐Whitehead, Ian K Maconochie, Harry Baumer, Morwenna Stewart

https://doi.org/10.1002/14651858.CD004786.pub2

2004 Apr 19

Fluid therapy for acute bacterial meningitis

Protocol

Richmal Marie Oates‐Whitehead, Ian K Maconochie, J H Baumer, Morwenna Stewart, Harry Baumer

https://doi.org/10.1002/14651858.CD004786

Differences between protocol and review

There were insufficient data to explore any of the subgroup analyses, with the exception of hypoperfusion at entry. One study (Singhi 1995) subgrouped each participant group into those with hyponatraemia and those without hyponatraemia at enrolment. Therefore, we could only perform a subgroup analysis on this trial.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 1 Death.
Figuras y tablas -
Analysis 1.1

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 1 Death.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 2 Severe neurological sequelae.
Figuras y tablas -
Analysis 1.2

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 2 Severe neurological sequelae.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 3 Mild to moderate neurological sequelae.
Figuras y tablas -
Analysis 1.3

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 3 Mild to moderate neurological sequelae.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 4 Hemiparesis/hemiplegia.
Figuras y tablas -
Analysis 1.4

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 4 Hemiparesis/hemiplegia.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 5 Spasticity.
Figuras y tablas -
Analysis 1.5

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 5 Spasticity.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 6 Seizures.
Figuras y tablas -
Analysis 1.6

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 6 Seizures.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 7 Visual impairment.
Figuras y tablas -
Analysis 1.7

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 7 Visual impairment.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 8 No response to sound.
Figuras y tablas -
Analysis 1.8

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 8 No response to sound.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 9 Oedema.
Figuras y tablas -
Analysis 1.9

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 9 Oedema.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 10 Total body water ‐ fall after 48 hours.
Figuras y tablas -
Analysis 1.10

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 10 Total body water ‐ fall after 48 hours.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 11 Extracellular water ‐ fall after 48 hours.
Figuras y tablas -
Analysis 1.11

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 11 Extracellular water ‐ fall after 48 hours.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 12 Serum sodium.
Figuras y tablas -
Analysis 1.12

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 12 Serum sodium.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 13 Urinary sodium.
Figuras y tablas -
Analysis 1.13

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 13 Urinary sodium.

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 14 Plasma osmolality ‐ change after 48 hours.
Figuras y tablas -
Analysis 1.14

Comparison 1 Maintenance fluids versus restricted fluids, Outcome 14 Plasma osmolality ‐ change after 48 hours.

Summary of findings for the main comparison. Maintenance fluids versus restricted fluids for acute bacterial meningitis in paediatric populations

Maintenance fluids versus restricted fluids for acute bacterial meningitis in paediatric populations

Patient or population: patients with acute bacterial meningitis in paediatric populations 1
Settings: Hospital Inpatient Department
Intervention: Maintenance fluids versus restricted fluids

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Maintenance fluids versus restricted fluids

Death ‐ all patients

Study population

RR 0.82
(0.53 to 1.27)

407
(2 studies)

⊕⊕⊕⊝
moderate2,3

186 per 1000

153 per 1000
(99 to 237)

Moderate

213 per 1000

175 per 1000
(113 to 271)

Severe neurological sequelae ‐ acute (within the first 4 weeks)

Study population

RR 0.67
(0.41 to 1.08)

407
(2 studies)

⊕⊝⊝⊝
very low3,4

176 per 1000

118 per 1000
(72 to 191)

Moderate

252 per 1000

169 per 1000
(103 to 272)

Severe neurological sequelae ‐ chronic (after the first 4 weeks)

Study population

RR 0.42
(0.2 to 0.89)

351
(1 study)

⊕⊕⊕⊝
moderate5,6

121 per 1000

51 per 1000
(24 to 107)

Moderate

121 per 1000

51 per 1000
(24 to 108)

Mild to moderate neurological sequelae

Study population

RR 1.24
(0.58 to 2.65)

357
(1 study)

⊕⊕⊕⊝
moderate7

62 per 1000

78 per 1000
(36 to 166)

Moderate

63 per 1000

78 per 1000
(37 to 167)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% Confidence Interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 No studies were found comparing different intravenous fluid regimens in adult populations in the systematic review.
2Duke 2002 and Singhi 1995 both have high risk of performance and detection bias, but this would not affect the mortality outcome. We did not downgrade in spite of the unclear risk of selection bias since it contributed to only 16.4% of weight and sensitivity analysis did not alter the effect estimates much. There was no risk of reporting bias for Singhi 1995 for the outcome of death.
3 The upper and lower limits of the 95% CI of the pooled estimate are very wide and thus indicate serious imprecision.
4 In Singhi 1995 selection bias was unclear and in both Duke 2002 and Singhi 1995 the performance and detection bias were at high risk. All this indicates very serious risk of bias for this outcome.
5 In Duke 2002 performance and detection bias were at high risk.
6 There was just one study so no downgrading was done for imprecision.
7Duke 2002 had a high risk of performance and detection bias which will cause serious risk of bias for evalulation of mild to moderate neurological sequelae.

Figuras y tablas -
Summary of findings for the main comparison. Maintenance fluids versus restricted fluids for acute bacterial meningitis in paediatric populations
Comparison 1. Maintenance fluids versus restricted fluids

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 All participants

2

407

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.53, 1.27]

1.2 Participants with hyponatraemia

1

26

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.50]

1.3 Participants without hyponatraemia

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.16, 3.90]

2 Severe neurological sequelae Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Acute (within the first 4 weeks)

2

407

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.41, 1.08]

2.2 Chronic (after the first 4 weeks)

1

351

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.20, 0.89]

2.3 Participants without hyponatraemia

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.13, 2.64]

2.4 Participants with hyponatraemia

1

26

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.34, 2.47]

3 Mild to moderate neurological sequelae Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Hemiparesis/hemiplegia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Spasticity Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Seizures Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Within the first 72 hours

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Visual impairment Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 No response to sound Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 At 14 days

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Oedema Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

9.1 Acute facial oedema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 Acute pulmonary oedema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Acute hydrocephalus

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Total body water ‐ fall after 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 Participants without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.2 Participants with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Extracellular water ‐ fall after 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11.1 Participants without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 Participants with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Serum sodium Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

12.1 All participants (24 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.2 Participants with hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.3 Participants without hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.4 Change from baseline at 48 hours ‐ without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.5 Change from baseline at 48 hours ‐ with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Urinary sodium Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

13.1 Participants without hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.2 Participants with hyponatraemia (48 hours)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.3 Change from baseline at 48 hours ‐ without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.4 Change from baseline at 48 hours ‐ with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Plasma osmolality ‐ change after 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

14.1 Participants without hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.2 Participants with hyponatraemia

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 1. Maintenance fluids versus restricted fluids