Parenteral Fluid Regimens for Improving Functional Outcome in People With Acute Stroke
Parenteral fluids are commonly used in people with acute stroke with poor oral fluid intake. This is primarily for maintenance of fluid intake. However, there is limited evidence on the balance between benefit and harm for different fluid regimens in patients with stroke.
We assessed whether different parenteral fluid regimens after stroke led to differences in death, or death or dependence, based on fluid type, fluid volume, duration of fluid administration, and mode of delivery.
In May 2015, we searched multiple databases, ongoing trials registers, reference lists, and forward citations and contacted authors. We included randomized controlled trials of parenteral fluid regimens in adults with ischemic or hemorrhagic stroke within 7 days of stroke onset that reported death or dependence. Where available, we collected data on complications of fluid therapy (pulmonary edema, cerebral edema, and pneumonia). Two review authors independently reviewed full text articles and extracted data. We used Cochrane’s tool for bias assessment.
We included 12 studies (2351 participants: range 27–841) that compared patients randomized to colloids with patients randomized to crystalloids. Five studies of these 12 studies (1420 participants) compared 0.9% saline with another fluid. There were no relevant completed trials that addressed the effect of volume, duration, or mode of fluid delivery on death or dependence in people with stroke.
The odds of death or dependence were similar in participants allocated to colloids or crystalloid fluid regimens (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.79–1.21, 5 studies, I2=58%, low-quality evidence; see Figure) and between 0.9% saline or other fluid regimens (OR 1.04, 95% CI 0.82–1.32, 3 studies, I2=71%, low-quality evidence). There was substantial heterogeneity in these estimates.1
The odds of death were similar between colloids and crystalloids (OR 1.02, 95% CI 0.82–1.27, 12 studies, I2=24%, moderate-quality evidence) and 0.9% saline and other fluids (OR 0.87, 95% CI 0.67–1.12, 5 studies, I2=53%, low-quality evidence).1
We found that the odds of pulmonary edema were higher in participants allocated to colloids (OR 2.34, 95% CI 1.28–4.29, I2=0%). Data on cerebral edema (OR 0.20, 95% CI 0.02–1.74) and pneumonia (OR 0.58, 95% CI 0.17–2.01) were consistent with benefit or harm from either fluid regime.1
There was no evidence to recommend a particular fluid type to improve functional outcome in the medium term after stroke. We found no evidence to guide the best volume, duration, or mode of parenteral fluid delivery for people with acute stroke.
Further collaborative clinical trials in people with acute stroke, studying type, volume, varying administration routes, and frequency of fluid therapy over a fixed duration would answer current uncertainties. This would aid clinicians in improving patient outcome.
This article is based on a Cochrane Review published in The Cochrane Library 2015, Issue 9 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.
We thank Hazel Fraser and the editors of the Cochrane Stroke Group for their support. In particular, we acknowledge the expertise of Brenda Thomas in developing the search strategy used.
William Whiteley was funded by a Medical Research Council Clinician Scientist Fellowship. The other authors report no conflicts.
- Received September 9, 2015.
- Accepted September 23, 2015.
- © 2015 American Heart Association, Inc.