Background: The treatment of rhabdomyolysis remains controversial. Although there is no question that any associated compartment syndrome needs to be identified and released, debate persists regarding the benefit of further therapy including aggressive intravenous fluid resuscitation (IVFR), urine alkalization with bicarbonate, and the use of mannitol. The goal of this practice management guideline was to evaluate the effects of bicarbonate, mannitol, and aggressive intravenous fluids on patients with rhabdomyolysis.

Methods: A systematic review and meta-analysis comparing treatments in patients with rhabdomyolysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of evidence and to create evidence-based recommendations regarding the use of bicarbonate, mannitol, and aggressive IVFR in patients with rhabdomyolysis.

Results: A total of 12 studies were identified for analysis. On quantitative analysis, IVFR decreased the incidence of acute renal failure (ARF) and need for dialysis in patients with rhabdomyolysis. Neither bicarbonate nor mannitol administration improved the incidence of acute renal failure and need for dialysis in patients with rhabdomyolysis. Quality of evidence was deemed to be very low, with the vast majority of the literature being retrospective studies.

Conclusion: In patients with rhabdomyolysis, we conditionally recommend for aggressive IVFR to improve outcomes of ARF and lessen the need for dialysis. We conditionally recommend against treatment with bicarbonate or mannitol in patients with rhabdomyolysis.

背景：横纹肌溶解的治疗仍存在争议。尽管不存在需要识别和释放任何相关筋膜间室综合征的问题，但关于进一步治疗获益的争论仍然存在，包括积极的静脉液体复苏 (IVFR)、碳酸氢盐尿液碱化和甘露醇的使用。本实践管理指南的目的是评价碳酸氢盐、甘露醇和积极静脉输液对横纹肌溶解患者的影响。

方法：进行系统综述和荟萃分析，比较横纹肌溶解患者的治疗。应用建议评估、开发和评价分级 (GRADE) 方法评估证据质量，并创建关于在横纹肌溶解症患者中使用碳酸氢盐、甘露醇和积极 IVFR 的循证建议。

结果：共确定了12项研究进行分析。定量分析，IVFR降低了横纹肌溶解患者急性肾衰竭 (ARF) 的发生率和透析的需求。碳酸氢盐或甘露醇给药均未改善横纹肌溶解患者的急性肾衰竭发生率和透析需求。证据质量被认为非常低，绝大多数文献为回顾性研究。

结论：在横纹肌溶解症患者中，我们有条件地建议进行积极的IVFR，以改善 ARF 结局并减少透析需求。我们有条件地建议横纹肌溶解症患者不要使用碳酸氢盐或甘露醇治疗。