Parenteral calcium for intensive care unit patients

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Analysis 1.1

Comparison 1 Calcium vs. placebo, Outcome 1 Calcium vs. placebo (infusion, early).

Analysis 1.2

Comparison 1 Calcium vs. placebo, Outcome 2 Calcium vs. placebo (infusion, late).

Analysis 1.3

Comparison 1 Calcium vs. placebo, Outcome 3 Calcium vs. placebo (bolus, early).

Analysis 1.4

Comparison 1 Calcium vs. placebo, Outcome 4 Calcium vs. placebo (bolus, late).

Analysis 1.5

Comparison 1 Calcium vs. placebo, Outcome 5 Calcium vs. placebo (neonates).

Analysis 1.6

Comparison 1 Calcium vs. placebo, Outcome 6 Calcium vs. placebo (hypocalcemia).

Table 1. Methods of calcium administration and measurement of calcium concentration

Study	Indication	Method	Calcium measurement
Auffant 1981	[Ca²⁺]i < 0.9 mmol/L	Calcium chloride Bolus (n=10): 5 mg/kg Infusion (n=7): 0.5 mg/kg/min	Preoperatively, during surgery, and every 15 minutes for 2 hours after beginning calcium administration
Butterworth 1992	Prophylaxis	Calcium chloride Group 1: 1 mg/kg/min for 20 minutes followed by 0.25 mg/kg/min for 5 minutes Group 2: 1 mg/kg/min for 20 minutes	Group 1: baseline, 25, 31, and 37 minutes after beginning calcium administration Group 2: baseline, every 5 minutes for 20 minutes after beginning calcium adminstration
Porcelli 1995	[Ca]t < 1.75 mmol/L	Calcium gluconate 100 mg/kg infused over 30‐60 minutes	One measurement at 3‐6 hours after administration
Scott 1984	[Ca²⁺]i < 0.63 mmol/dL	Calcium gluconate Bolus: 200 mg/kg every 6 hours at 100 mg/min Infusion: 400 mg/kg/24h (˜0.278 mg/kg/min)	Every 6 hours for 24 hours after beginning calcium administration Every 6 hours for 24 hours after beginning calcium administration
Zaloga 1990	Prophylaxis	Calcium chloride 10 mg/kg bolus followed by 2 mg/kg/h	Baseline, 10, 20, 24, 32, 36, and 44 minutes after beginning calcium administration
[Ca²⁺]i = ionized calcium concentration

Table 1. Methods of calcium administration and measurement of calcium concentration

Comparison 1. Calcium vs. placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Calcium vs. placebo (infusion, early) Show forest plot	3	83	Mean Difference (IV, Random, 95% CI)	0.24 [‐0.00, 0.49]

2 Calcium vs. placebo (infusion, late) Show forest plot	3	74	Mean Difference (IV, Random, 95% CI)	0.12 [‐0.02, 0.26]

3 Calcium vs. placebo (bolus, early) Show forest plot	1	17	Mean Difference (IV, Random, 95% CI)	0.08 [0.05, 0.11]

4 Calcium vs. placebo (bolus, late) Show forest plot	2	35	Mean Difference (IV, Random, 95% CI)	0.05 [‐0.01, 0.12]

5 Calcium vs. placebo (neonates) Show forest plot	2	70	Mean Difference (IV, Random, 95% CI)	0.06 [0.01, 0.11]

6 Calcium vs. placebo (hypocalcemia) Show forest plot	3	93	Mean Difference (IV, Random, 95% CI)	0.09 [0.02, 0.16]

Comparison 1. Calcium vs. placebo