Another nail in the saline coffin

Priebe, Hans‐Joachim

doi:10.1016/j.bja.2018.02.026

Cited by 1 publication

(3 citation statements)

References 19 publications

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“…In the present study, we acknowledge that the low chloride load associated with the administration of small volumes of saline was well tolerated by our patient cohort, because they were at low risk for AKI. Moreover, we also acknowledge that our findings are not generalisable to patients with pre-existing renal dysfunction, those with metabolic acidosis and those receiving large volumes of hyperchloraemic solutions [ 31 ]. Recent editorials have emphasised that renal function is frequently unknown during surgery, and the volume of fluid replacement is unpredictable in acute care settings [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, we also acknowledge that our findings are not generalisable to patients with pre-existing renal dysfunction, those with metabolic acidosis and those receiving large volumes of hyperchloraemic solutions [ 31 ]. Recent editorials have emphasised that renal function is frequently unknown during surgery, and the volume of fluid replacement is unpredictable in acute care settings [ 31 ]. Therefore, because there is no evidence of benefit from hyperchloraemic solutions (other than in the management of metabolic alkalosis or hyponatraemia) and there is potential harm, there appears to be no physiologic or clinical justification for the continued use of “unphysiological” saline (or any other unbalanced crystalloid solution) for perioperative volume therapy, especially when safer and more physiological solutions are available [ 31 – 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, concerns about the potentially harmful effects of hyperchloraemia remain. The clinical practice of using IV fluid solutions with unphysiological concentrations of chloride has been strongly discouraged due to the significant association between hyperchloraemia and the development of metabolic acidosis and adverse renal outcomes [30][31][32]. Moreover, for clinical trials investigating the effects of hyperchloraemic versus balanced solutions, clinical equipoise has also been recently questioned for the continued use of hyperchloraemic solutions in patients who develop hyperchloraemia [30].…”

Section: Plos Onementioning

confidence: 99%

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The effects of 0.9% saline versus Plasma-Lyte 148 on renal function as assessed by creatinine concentration in patients undergoing major surgery: A single-centre double-blinded cluster crossover trial

Weinberg

Чурилов

et al. 2021

PLoS ONE

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Objectives Saline and Plasma-Lyte have different physiochemical contents; consequently, they may differently affect patients’ renal function. We compared the effects of fluid therapy with 0.9% saline and with Plasma-Lyte 148 on renal function as assessed by creatinine concentration among patients undergoing major surgery. Methods We conducted a prospective, double-blinded cluster crossover trial comparing the effects of the two fluids on major surgery patients. The primary aim was to establish the pilot feasibility, safety and preliminary efficacy evidence base for a large interventional trial to establish whether saline or Plasma-Lyte is the preferred crystalloid fluid for managing major surgery patients. The primary efficacy outcome was the proportion of patients with changes in renal function as assessed by creatinine concentration during their index hospital admission. We used changes in creatinine to define acute kidney injury (AKI) according to the RIFLE criteria. Results The study was feasible with 100% patient and clinician acceptance. There were no deviations from the trial protocol. After screening, we allocated 602 patients to saline and 458 to Plasma-Lyte. The median (IQR) volume of intraoperative fluid received was 2000 mL (1000:2000) in both groups. Forty-nine saline patients (8.1%) and 49 Plasma-Lyte patients (10.7%) developed a postoperative AKI (adjusted incidence rate ratio [aIRR]: 1.34; 95% CI: 0.93–1.95; p = 0.120). No differences were observed in the development of postoperative complications (aIRR: 0.98; 95% CI: 0.89–1.08) or the severity of the worst complication (aIRR: 1.00; 95% CI: 0.78–1.30). The median (IQR) length of hospital stay was six days (3:11) for the saline group and five days (3:10) for the Plasma-Lyte group (aIRR: 0.85; 95% CI: 0.73–0.98). There were no serious adverse events relating to the trial fluids, nor were there fluid crossover or contamination events. Conclusions The study design was feasible to support a future follow-up larger clinical trial. Patients treated with saline did not demonstrate an increased incidence of postoperative AKI (defined as changes in creatinine) compared to those treated with Plasma-Lyte. Our findings imply that clinicians can reasonably use either solution intraoperatively for adult patients undergoing major surgery. Trial registration Registry: Australian New Zealand Clinical Trials Registry; ACTRN12613001042730; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364988.

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Section: Resultsmentioning

confidence: 99%