Effect of Restrictive Versus Liberal Fluid Management Strategies on Major Adverse Kidney Events in Critically Ill Adult Patients: A Protocol for a Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract BackgroundIntravenous fluid therapy is ubiquitous in intensive care units (ICUs). There is increasing recognition of the value of restrictive fluid management strategies, including improved survival and renal function. However, these strategies have not been universally adopted. The purpose of this protocol is to outline our plan for investigating the current literature on the topic of restrictive versus liberal fluid management strategies in all critically ill adults and their associated outcomes, namely major adverse kidney events (MAKE). Methods We will conduct a systematic review and meta-analysis of randomized controlled trials evaluating fluid management strategies in critically ill adults. A search strategy was created with the help of medical librarians, using Ovid MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, and The Cochrane Library. Four independent researchers will perform study selection and data extraction in duplicate. The primary outcome of this study is detection of MAKE by 30 days. Secondary outcomes include reporting MAKE at 60 and 90 days; and mortality, new onset renal replacement therapy, and persistent renal dysfunction at 30, 60, and 90 days. If appropriate, we will perform a meta-analysis using a DerSimonian and Laird random-effects model. Subgroups will include patient type, ICU type, and study quality. Certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach.DiscussionThe results of this study will synthesize current evidence and better inform the optimal fluid management strategy in critically ill adults.Systematic review registration: Submitted to PROSPERO on June 16th, 2021.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.092 | 0.139 |
| Meta-epidemiology (narrow) | 0.006 | 0.005 |
| Meta-epidemiology (broad) | 0.022 | 0.037 |
| Bibliometrics | 0.011 | 0.011 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.008 | 0.007 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.008 | 0.007 |
| Insufficient payload (model declined to judge) | 0.044 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".