Isotonic crystalloid solutions: a structured review of the literature

Cortés, D. Orbegozo; Bonor, A. Rayo; Vincent, Jean‐Louis

doi:10.1093/bja/aeu047

Cited by 72 publications

(25 citation statements)

References 53 publications

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“…This is because physiologic saline solution causes hyperchloremic acidosis in a dose-dependent manner [30]. In comparison to balanced solutions, this reduces splanchnic bed and renal perfusion, reduces urine excretion, and increases the incidence of nausea and vomiting [31]. There are also indications that balanced solutions are associated with advantages in terms of patient survival [32].…”

Section: Crystalloidsmentioning

confidence: 99%

State of the art in fluid and volume therapy

et al. 2017

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Section: Crystalloidsmentioning

confidence: 99%

State of the art in fluid and volume therapy

et al. 2017

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“…(7,8,10) A meta-analysis including fourteen studies with 18,916 adult septic patients suggested that resuscitation with balanced crystalloids compared with unbalanced crystalloids (0.9% saline) may be associated with a lower mortality rate (odds ratio - OR, 0.78; 95% confidence interval - 95%CI, 0.58 to 1.05). (7) More recently, another network meta-analysis that included ten randomized clinical trials with 6,664 septic patients showed no significant difference in the need for renal replacement therapy (RRT) between balanced crystalloids and 0.9% saline (OR, 0.85; 95% CI, 0.56 to 1.30).…”

Section: Studies In Septic and Non-septic Critically Ill Patientsmentioning

confidence: 99%

“…Although it appears that all crystalloid solutions have similar hemodynamic effects, (10) the impact of intravascular volume expansion with balanced solutions on regional and microcirculatory blood flow, tissue perfusion, mitochondrial function, systemic inflammation and coagulation need to be further evaluated in both experimental and clinical studies. (10) Furthermore, this review, as with any non-systematic narrative review, may have limitations in terms of the comprehensiveness of the search strategy used to identify relevant papers and the lack of standardization of methods for data extraction, analysis and interpretation.…”

Section: Future Directionsmentioning

confidence: 99%

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Balanced crystalloids for septic shock resuscitation

Corrêa

Cavalcanti

Assunção

2016

Revista Brasileira De Terapia Intensiva

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Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial.

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“…En una revisión estructurada de la evidencia disponible 72 se aprecia una mayor incidencia de acidosis hiperclorémica con el uso de solución salina al 0,9% y un aumento en los niveles de lactato cuando se infunden grandes volúmenes de solución de Ringer lactato. Aunque los datos disponibles son limitados, en pacientes de alto riesgo, la administración de solución salina al 0,9% parece estar asociada con una mayor hemorragia y transfusión de hematíes en comparación con el Ringer lactato.…”

Section: Seguridad De Los Cristaloidesunclassified

Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico

Gómez

Vives

Basora³

et al. 2015

Medicina Intensiva

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Cómo citar este artículo: Muñoz Gómez M, et al. Resumen Estos últimos años han aparecido alertas de seguridad, no siempre bien sustentadas, que cuestionan el uso de algunas alternativas farmacológicas a la transfusión de sangre alogénica y/o lo restringen en indicaciones establecidas. Asistimos también a la preconización de otras alternativas, incluyendo productos hemáticos y fármacos antifibrinolíticos, sin que haya una base científica sólida que lo justifique. Por iniciativa del Grupo de Estudios Multidisciplinares sobre Autotransfusión y del Anemia Working Group España se reunió a un panel multidisciplinar de 23 expertos del área de cuidados de la salud en un foro de debate para: 1) analizar las diferentes alertas de seguridad en torno a ciertas alternativas a la transfusión; 2) estudiar los antecedentes que las han propiciado, la evidencia que las sustentan y las consecuencias que conllevan para la práctica clínica, y 3) emitir una valoración argumentada de la seguridad de cada alternativa a la transfusión cuestionada, según el uso clínico de la misma.Los integrantes del foro mantuvieron contactos por vía telemática y una reunión presencial en la que presentaron y discutieron las conclusiones sobre cada uno de los elementos examinados. Se elaboró un primer documento que fue sometido a 4 rondas de revisión y actualización hasta alcanzar un consenso, unánime en la mayoría de los casos. Presentamos la versión final del documento, aprobada por todos los miembros del panel, esperando sea de utilidad para nuestros colegas. © 2015 Elsevier España, S.L.U. y SEMICYUC. Todos los derechos reservados. Abstract In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. KEYWORDSThe Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use.The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

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Isotonic crystalloid solutions: a structured review of the literature

Abstract: Different solutions have different effects on acid-base status, electrolyte levels, coagulation, renal, and hepatic function. Whether these differences have clinical consequences remains unclear.

Cited by 72 publications

References 53 publications

State of the art in fluid and volume therapy

State of the art in fluid and volume therapy

Balanced crystalloids for septic shock resuscitation

Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico

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