Acetate‐ vs lactate‐buffered crystalloid solutions: Protocol for a systematic review with meta‐analysis and trial sequential analysis

Ellekjær, Karen Louise; Perner, Anders; Sivapalan, Praleene; Møller, Morten Hylander

doi:10.1111/aas.13703

Cited by 2 publications

(15 citation statements)

References 23 publications

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“…Trials in which patients were randomised to other supplemental IV fluids in both the intervention and control group were permitted, if identical solutions were administered in both arms. 18 2.4 | Types of outcome measures…”

Section: Types Of Interventionsmentioning

confidence: 99%

“…We reported the most conservative treatment effect estimate using either fixed or random effects models. 18 The primary result is based on data from all available trials regardless of the risk of bias evaluation.…”

Section: Measures Of Treatment Effectmentioning

confidence: 99%

“…32 We did not conduct sensitivity analysis with best-to-worst-case and worst-to-best-case scenarios, as no trials reported loss to follow-up. 18…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…30,31,35 According to our statistical analysis plan, we considered p < .05 as statistically significant for the primary-and secondary outcomes, given that we had data available for analysis for only one of eight secondary outcomes. 18 As per our protocol we do not present TSA details or plots if, according to the TSA, <5% of the diversity-adjusted required information size was accrued. 18 2.6.8 | Assessment of the overall quality of evidence Two authors (K.L.E.…”

Section: Assessment Of Risk Of Random Errorsmentioning

confidence: 99%

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Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis

Ellekjær

Perner

Sivapalan

et al. 2022

Acta Anaesthesiol Scand

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Objective: There is a widespread use of buffered crystalloid solutions in clinical practice. However, guidelines do not distinguish between specific types of buffered solutions and clinical equipoise exists. We aimed to assess the desirable and undesirable effects of acetate-versus lactate-buffered solutions in hospitalised patients.Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials assessing the use of acetate-versus lactatebuffered solutions for intravenous administration in hospitalised adults and children.The primary outcome was all-cause short-term mortality. We adhered to our published protocol, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Results:We included five RCTs enrolling 390 patients. We found no statistically significant difference in short-term mortality (random effects, risk ratio [RR] 0.29; 95% confidence interval [CI] 0.06-1.51, p = .14, I 2 = 0%) or hospital length of stay (LOS) (random effects, mean difference [MD]-1.31, 95% CI À3.66 to 1.05, p = .28, I 2 = 0%) between acetate-versus lactate-buffered solutions. The quality of evidence was very low. Data regarding intensive care unit LOS were reported by three trials and duration of vasopressor treatment by one trial; none of these data allowed for pooling in metaanalyses. No trials reported data on long-term mortality, health-related quality of life, adverse events, duration of mechanical ventilation or renal replacement therapy. Conclusion:In this systematic review, we found very low quantity and quality of evidence on the use of acetate-versus lactate-buffered solutions in hospitalised patients.

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Section: Types Of Interventionsmentioning

confidence: 99%

Section: Measures Of Treatment Effectmentioning

confidence: 99%

“…32 We did not conduct sensitivity analysis with best-to-worst-case and worst-to-best-case scenarios, as no trials reported loss to follow-up. 18…”

Section: Sensitivity Analysismentioning

confidence: 99%

Section: Assessment Of Risk Of Random Errorsmentioning

confidence: 99%

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Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis

Ellekjær

Perner

Sivapalan

et al. 2022

Acta Anaesthesiol Scand

Self Cite

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“…The metabolism of lactate is dependent on the kidney and liver. Unlike lactate, acetate is also more rapidly metabolised with less oxygen demand and extra hepatic [ 6 ]. Therefore it could reduce the liver metabolic burden, especially in infants who already had liver function damage.…”

Section: Introductionmentioning

confidence: 99%

The effect of acetate Ringer’s solution versus lactate Ringer’s solution on acid base physiology in infants with biliary atresia

et al. 2021

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Background The choice of the perioperative crystalloid is a key component of the fluid management and must take into account the liver function and the appearing metabolic disorders to avoid increase the liver extra metabolism. The aim of this study is to analyze the effect of acetate Ringer’s solution or lactate Ringer’s solution in biliary atresia patients. Methods We included 68 infant patients aged between 21 ~ 65 d, ASA physical status II or III, who underwent elective Kasai hepatoportoenterostomy, received either AR and LR for intravenous fluid resuscitation according to their group allocation. Lactate concentration, serum electrolytes and pH were noteded before skin incision (T1), end of surgery (T2) and postoperative 12 h. We also recorded the time of operation, stay of hospital, loss of blood and urinary, total volume of infusion of crystalloid. Results Lactate level was significantly higher in Group LR than in Group AR patients at T2 (0.76 ± 0.13 versus 0.57 ± 0.22, P = 0.03). Compared with T3, sodium and chlorine were significantly higher in two groups at T2 (145.2 ± 3.1 versus 143.4 ± 3.4 and 104.6 ± 3.7 versus 105.2 ± 2.1). No significant differences were noted in potassium, HCO3− and calcium. There was no statistically significant difference in pH. No glycopenia was recorded in two groups. No significant difference was noted in administration of vasoactive drug (0.7% versus 1%). Conclusions Resuscitation with AR and LR was associated with similar clinical improvement in infants with biliary atresia. Use of AR reduced the level of lactate comparison with LR.

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Acetate‐ vs lactate‐buffered crystalloid solutions: Protocol for a systematic review with meta‐analysis and trial sequential analysis

Cited by 2 publications

References 23 publications

Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis

Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis

The effect of acetate Ringer’s solution versus lactate Ringer’s solution on acid base physiology in infants with biliary atresia

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