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

Abstract

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.

Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis

“…In two previously published meta-analyses evaluating the difference between both fluid types in unselected patient’s population involving surgical patients in perioperative period and kidney transplant in addition to critically ill patients, there was no difference in in-hospital mortality and incidence of AKI in both groups. Although both reviews have several limitations including the heterogeneity in patient’s population, and small sample size and few studies evaluated only critically ill patients, their results were in concordance with the results of our meta-analysis which was conducted exclusively in critically ill patients [ 13 , 19 ].…”

“…A recent meta-analysis concluded that balanced fluids are more beneficial than isotonic saline in keeping postoperative electrolytes and acid-base balance among adult patients undergoing non-renal surgery [ 12 ]. On the other hand, a meta-analysis comparing between balanced and isotonic saline in operation rooms and ICUs showed no difference in AKI neither in-hospital mortality between the two fluid types [ 13 ].…”

The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

“…20,21 Furthermore, unlike balanced crystalloid solutions, fluid resuscitation with normal saline has been associated with hyperchloremic metabolic acidosis, which can lead to several adverse effects including renal vasoconstriction, reduced gastric perfusion, and increased release of inflammatory markers. [23][24][25] The IP CC Admit Order Set is primarily used by rotating medical residents admitting patients to the medical intensive care unit (MICU) at our health system's largest institution. The MICU is a 14-bed unit that operates under a closed ICU model.…”

Crystalloid agents used in perioperative infusion therapy in children

“…Авторы утверждают, что раствор 0,9% натрия хлорида может быть более «искусным» в достижении целей инфузионной терапии, чем сбалансированные кристаллоидные препараты [46]. Данные метаанализа рандомизированных проспективных исследований, обзора тематической литературы также не показали преимущества использования сбалансированных растворов в инфузионной терапии [11,47]. В то же время Xue M. et al (2019) наоборот утверждают, что использование сбалансированных кристаллоидных растворов способствует снижению продолжительности механической вентиляции легких, снижению внутрибольничной смертности, снижению колебаний уровня электролитов и избытка оснований в крови [48].…”