Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children

Antequera, Alba; Barea‐Mendoza, Jesús Abelardo; Muriel, Alfonso; Sáez, Ignacio; Chico‐Fernández, Mario; Estrada-Lorenzo, José-Manuel; Plana, María Nieves

doi:10.1002/14651858.cd012247.pub2

Cited by 43 publications

(42 citation statements)

References 95 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This vehicle bypassed the problem of a bicarbonate-based buffer being affected by respiratory, metabolic, or renal status during pancreatitis, and also that of a phosphate buffer reacting with and neutralizing the administered calcium before it reacted with NEFA. Our approach of using saline (pH 7.4) as a vehicle thus made the study agnostic to the pH in vivo, and is in agreement with a recent meta-analysis covering studies with >20,000 critically ill patients, which concluded that buffered solutions do not provide any survival benefit over normal saline [14].…”

Section: Discussionsupporting

confidence: 84%

“…Lactate infusion reduces the drop in serum bicarbonate [8] and may protect from acidosis. Recently, a Cochran database study of evidence concluded that buffered solutions do not provide any benefit over 0.9% saline in reducing in hospital mortality among critically ill patients with a high degree of certainty [14]. Collectively, these suggest that the benefits of RL are noted in early severe pancreatitis and may be from a mechanism other than its being buffered or containing lactate.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

Khatua

Yaron

El-Kurdi

et al. 2020

JCM

View full text Add to dashboard Cite

Objective: Ringer’s lactate may improve early systemic inflammation during critical illnesses like severe acute pancreatitis, which are associated with hypocalcemia. Ringer’s lactate is buffered and contains lactate and calcium. We, thus analyzed extracellular calcium or lactate’s effects on the mechanisms, intermediary markers, and organ failure in models mimicking human disease with nonesterified fatty acid (NEFA) elevation. Methods: Meta-analyses and experimental studies were performed. Experimentally, extracellular calcium and lactate were compared in their interaction with linoleic acid (LA; a NEFA increased in human severe pancreatitis), and its subsequent effects on mitochondrial depolarization and cytosolic calcium signaling resulting in cell injury. In vivo, the effect of LA was studied on organ failure, along with the effect of calcium or lactate (pH 7.4) on severe acute pancreatitis-associated organ failure. A meta-analysis of human randomized control trials comparing Ringer’s lactate to normal saline was done, focusing on necrosis and organ failure. Results: Calcium reacted ionically with LA and reduced lipotoxic necrosis. In vivo, LA induced organ failure and hypocalcemia. During severe pancreatitis, calcium supplementation in saline pH 7.4, unlike lactate, prevented hypocalcemia, increased NEFA saponification, reduced circulating NEFA and C-reactive protein, reduced pancreatic necrosis adjacent to fat necrosis, and normalized shock (carotid pulse distension) and blood urea nitrogen elevation on day 1. This, however, did not prevent the later increase in serum NEFA which caused delayed organ failure. Meta-analysis showed Ringer’s lactate reduced necrosis, but not organ failure, compared with normal saline. Conclusion: Hypocalcemia occurs due to excess NEFA binding calcium during a critical illness. Ringer’s lactate’s early benefits in systemic inflammation are by the calcium it provides reacting ionically with NEFA. This, however, does not prevent later organ failure from sustained NEFA generation. Future studies comparing calcium supplemented saline resuscitation to Ringer’s lactate may provide insights to this pathophysiology.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

Khatua

Yaron

El-Kurdi

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…This beneficial effect was replicated in non-critically ill patients and in the perioperative setting 75 , 76 . However, three systematic reviews of studies in adults and children did not demonstrate reduced rates of AKI or mortality with balanced crystalloids compared with saline in pooled analyses 79 – 81 . Given the possible harm caused by the use of 0.9% saline we recommend using balanced fluids, unless there is an indication for other types of fluid (e.g.…”

Section: Prevention and Management Of Akimentioning

confidence: 99%

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

et al. 2020

View full text Add to dashboard Cite

Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

show abstract

“…With normal saline being associated with unwarranted effects such as hyperchloremic acidosis and possibly increased risk of acute kidney injury, use of the more recently introduced buffered solutions has steadily increased 8 . However, clinical practice guidelines do not distinguish between the different types of buffered solutions 9,10 . As buffered salt solutions have varying compositions, considering them as a ‘class’ of fluid could potentially cause for misinterpretation of individual effects.…”

Section: Introductionmentioning

confidence: 99%

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

Ellekjær

Perner

Sivapalan

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background Buffered crystalloid solutions are increasingly recommended as first‐line resuscitation fluids. However, guidelines do not distinguish between different types of buffered solutions. The aim of the outlined systematic review is to summarize and assess the effects of acetate‐ vs lactate‐buffered crystalloid solutions on patient‐important outcomes. Methods We will conduct a systematic review of randomized clinical trials (RCTs) with meta‐analysis and trial sequential analysis comparing the use of acetate‐ vs lactate‐buffered crystalloid solutions in hospitalized patients. We will systematically search the Cochrane Library, MEDLINE, EMBASE, and Epistemonikos for relevant literature. We will follow the recommendations set by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) statement. The risk of systematic errors (bias) and random errors will be assessed, and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Discussion The outlined systematic review will provide important data on how patient‐important outcomes are affected by intravenous administration of acetate‐ vs lactate‐buffered crystalloid solutions in hospitalized patients.

show abstract

Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children

Abstract: Bu ered solutions versus 0.9% saline for resuscitation in critically ill adults and children.

Cited by 43 publications

References 95 publications

Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

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

Contact Info

Product

Resources

About