Advising patients to increase fluid intake for treating acute respiratory infections

 

Abstract

Background

Acute respiratory infection is a common reason for people to present for medical care. Advice to increase fluid intake is a frequent treatment recommendation. Attributed benefits of fluids include replacing increased insensible fluid losses, correcting dehydration from reduced intake and reducing the viscosity of mucus. However, there are theoretical reasons for increased fluid intake to cause harm. Anti-diuretic hormone secretion is increased in lower respiratory tract infections of various aetiologies. This systematic examination of the evidence sought to determine the benefit versus harm from increasing fluid intake.

Objectives

To answer the following questions.

1. Does recommending increased fluid intake as a treatment for acute respiratory infections improve duration and severity of symptoms?
2. Are there adverse effects from recommending increased fluids in people with acute respiratory infections?
3. Are any benefits or harms related to site of infection (upper or lower respiratory tract) or a different severity of illness?

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 4), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to November Week 3, 2010), EMBASE (1974 to December 2010), Current Contents (2000 to December 2010) and CINAHL (1982 to December 2010). We searched reference lists of articles identified and contacted experts in the relevant disciplines.

Selection criteria

Randomised controlled trials (RCTs) that examined the effect of increasing fluid intake in people with acute respiratory infections.

Data collection and analysis

Two review authors independently assessed the identified studies to determine eligibility for inclusion.

Main results

No RCTs assessing the effect of increasing fluid intake in acute respiratory infections were found.

Authors' conclusions

There is currently no evidence from RCTs for or against the recommendation to increase fluids in acute respiratory infections. The implications for fluid management of acute respiratory infections in the outpatient or primary care setting have not been studied in any RCTs to date. Some non-experimental (observational) studies report that increasing fluid intake in acute respiratory infections of the lower respiratory tract may cause harm. RCTs need to be done to determine the true effect of this very common medical advice.

 

Plain language summary

Advising patients to increase fluid intake for treating acute respiratory infections

Doctors commonly recommend that people with acute respiratory infections drink extra fluids. Acute infections include colds, acute sinusitis, tonsillitis, laryngitis, bronchitis, pneumonia and influenza. This review intended to find out the benefit or harm from this recommendation. Potential benefits of fluids are replacing fluid lost because of fever or rapid breathing, treating dehydration and reducing the viscosity of mucus. In infections of the lower part of the respiratory tract, possible harmful effects of fluids might be a dilution of the blood sodium concentration, leading to headache, confusion and seizures. This review found no evidence for or against the use of increased fluids in acute respiratory infections. No randomised controlled trials have been conducted to determine the benefit or harm from extra fluids. It is important that further studies be done in order to determine the true effect of this very common medical advice.

 

摘要

背景

建議急性呼吸道感染病患增加水份攝取

急性呼吸道感染是病患尋求醫療協助的常見理由。增加水份的攝取是常見的處理建議。增加水份攝取被認為可以補充未察覺的體液流失、矯正因為食慾下降造成的脫水，並且減少呼吸道黏液的黏性。然而也有理論認為增加水份攝取可能會帶來危害。多類病原造成的下呼吸道感染會增加抗利尿激素(Antidiuretic hormone)的分泌。這篇系統回顧希望可以找到增加水份攝取可能帶來的好處或壞處的證據。

目標

回答以下的問題。(1)建議病患增加水份的攝取來處理急性呼吸道感染是否可以改善症狀的持續時間和嚴重度？(2)增加水份攝取來處理急性呼吸道感染是否會帶來危害？(3)增加水份攝取的好處或壞處和呼吸道感染的位置(上呼吸道或下呼吸道)或嚴重程度是否有相關？

搜尋策略

我們搜尋了以下的資料庫：the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966年到2005年7月第1週), EMBASE (1974年到2005年第29週), Current Contents (最近5年)和CINAHL (1982年到2005年7月第3週).找到的文章所附的參考文獻也列入搜尋。此外相關領域的專家也列入聯絡的對象。

選擇標準

增加水份攝取對急性呼吸道感染處理效果的隨機對照試驗(Randomised controlled trials)。

資料收集與分析

每一位作者會對找到的研究做評估，決定研究是否適合納入分析。

主要結論

並沒有找到任何符合「增加水份攝取對急性呼吸道感染處理效果」相關的隨機對照試驗。

作者結論

目前並沒有證據支持或反對建議病患增加水份的攝取來處理急性呼吸道感染。到目前為止並沒有任何的隨機對照試驗是針對急性呼吸道感染病患的水份攝取問題。有一些非實驗(觀察性)的研究認為增加水份攝取可能會對急性呼吸道感染病患帶來傷害。為了決定這個常見醫療建議(增加水份攝取)真正的效果，進行隨機對照試驗是必要的。

翻譯人

本摘要由慈濟醫院邱雲柯翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

醫師常常會建議病患增加水份的攝取來處理急性呼吸道感染。急性的感染包括感冒、急性鼻竇炎、扁桃腺炎、咽峽炎以及流行性感冒。這篇回顧文章試著找出這個建議可能帶來的好處和壞處。可能的好處是補充因為發燒或呼吸急促造成的體液流失、矯正脫水，並且減少呼吸道黏液的黏性。可能的壞處是稀釋了血鈉的濃度而造成頭痛、意識混亂以及抽搐(seizure)。本篇回顧文章並沒有找到支持或反對建議病患增加水份的攝取來處理急性呼吸道感染的證據。目前並沒有任何的隨機對照試驗是針對額外水份攝取帶來的好處或壞處來研究。為了決定這個常見醫療建議(增加水份攝取)真正的效果，進行後續的研究是非常重要的。