A balanced view of balanced solutions

Guidet, Bertrand; Soni, Neil; Rocca, Giorgio Della; Kozek, Sibylle A.; Vallet, B.; Annane, Djillali; James, Mike

doi:10.1186/cc9230

Cited by 184 publications

(142 citation statements)

References 52 publications

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“…Balanced crystalloid solutions more closely resemble the electrolyte composition of plasma (5). The potential clinical benefit from resuscitation with balanced solutions comes from the lower chloride content, as development of dilutional acidosis could increase the inflammatory response (6,7), and decrease splanchnic perfusion (8), myocardial contractility (9) and the cardiovascular catecholamine response (10).…”

Section: Introductionmentioning

confidence: 99%

Balanced versus isotonic saline resuscitation—a systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units

et al. 2017

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Background: Fluid resuscitation is the cornerstone in treatment of shock, and intravenous fluid administration is the most frequent intervention in operation rooms and intensive care units (ICUs). The composition of fluids used for fluid resuscitation gained interest over the past decade, with recent focus on whether balanced solutions should be preferred over isotonic saline.Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing fluid resuscitation with a balanced solution versus isotonic saline in adult patients in operation room or ICUs.Primary outcome was in-hospital mortality, secondary outcomes included occurrence of acute kidney injury (AKI) and need for renal replacement therapy (RRT).Results: The search identified 11 RCTs involving 2,703 patients; 8 trials were conducted in operation room and 3 in ICU. In-hospital mortality, as well as the occurrence of AKI and need for RRT was not different between resuscitation with balanced solutions versus isotonic saline, neither in operation room nor in ICU patients. Serum chloride levels, but not arterial pH, were significantly lower in patients resuscitated with balanced solutions. Conclusions:Currently evidence insufficiently supports the use of balanced over isotonic saline for fluid resuscitation to improve outcome of operation room and ICU patients.

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Section: Introductionmentioning

confidence: 99%

Balanced versus isotonic saline resuscitation—a systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units

et al. 2017

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“…0.9% NaCl, may be harmful [5], novel crystalloid solutions have become available in our clinical practice, namely intravenous balanced solutions [6]. As we will see, with the term "balanced fluids", researchers, clinicians, and industry define intravenous solutions whose electrolyte composition is closer to the composition of plasma, as compared to previously available solutions.…”

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confidence: 99%

Intravenous balanced solutions: from physiology to clinical evidence

Länger

Santini

Scotti

et al. 2015

Anaesthesiol Intensive Ther

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Abstract"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental alteration of renal function associated with hyperchloremia. Despite efforts made towards its identification, the ideal balanced solution, with minimal effects on acid-base status, low chloride content, and adequate tonicity, is not yet available. After the accumulation of pre-clinical and clinical physiologic data, in the last three years, several clinical trials, mostly observational and retrospective, have addressed the question of whether the use of balanced solutions has beneficial effects as compared to the standard of care, sometimes even suggesting an improvement in survival. Nonetheless, the first large randomized controlled trial comparing the effects of a balanced vs. unbalanced solutions on renal function in critically-ill patients (SPLIT trial, the 0.9% saline vs. Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy), just recently published, showed identical equipoise between the two treatments. In the present review, we offer a comprehensive and updated summary on this issue, firstly, by providing a full physiological background of balanced solutions; secondly, by summarizing their potential pathophysiologic effects; and lastly, by presenting the clinical evidence available to support their use at the present time.

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“…These solutions have electrolyte composition and SID near similar to plasma (Guidet et al 2010). The likelihood of developing hyperchloraemia is less compared to normal saline.…”

Section: Introductionmentioning

confidence: 99%

Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

Muhamad¹

2017

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ABSTRAK Penggantian cecair adalah rawatan utama untuk kencing manis ketoacidosis (DKA). Pada masa ini pilihan terbaik daripada cecair masih diperdebatkan. 0.9% Normal Saline (NS) yang menyebabkan ketidakseimbangan metabolik dan asidosis metabolik biasanya digunakan. Sterofundin® merupakan kristaloid & Health Dec 2017;12(2): 179-192 Rossman H. et al. (Malaysian Clinical Practice Guidelines 2015). The ideal fluid for managing diabetic ketoacidosis (DKA) is controversial. Following substantial fluid loss due to osmotic diuresis, fluid deficit can be estimated up to 100 ml/ kg which is corrected within 24 hrs. Crystalloid 0.9% normal saline (NS) is currently the mainstay therapy for fluid replacement. Fluid replacement regiment for a systolic BP > 90 mmHg is 1000 mL of NS for the 1 st hr, another 1000 mL of NS for next 2 hrs and 1000 Kata kunci: jurang anion, diabetic ketoacidoses, keton, ph , saline, sterofundin ABSTRACTFluid replacement is the mainstay treatment for diabetic ketoacidosis (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride is commonly used. Sterofundin® is an alternative crystalloid that is assumed to expedite resolution of acidosis. Advantages in sterofundin content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other objectives were to compare significant ion difference (SID), 12-hr blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs. Sterofundin = +0.05, P=0.063), however not being significant. Ketone, anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median chloride levels increments were higher in the NS group (+11) compared to the sterofundin group (+6). There was no difference between mortality and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.

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A balanced view of balanced solutions

Cited by 184 publications

References 52 publications

Balanced versus isotonic saline resuscitation—a systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units

Balanced versus isotonic saline resuscitation—a systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units

Intravenous balanced solutions: from physiology to clinical evidence

Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

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