Meta-analysis of the effects of normal saline on mortality in intensive care

González-Castro, A.; Ortiz-Lasa, María; Rodríguez-Borregán, J.C.; Escudero-Acha, P.; Chicote, Enrique; Suberviola, Borja; Blanco, C.; Peñasco, Yhivian; Alfonso, A. Jiménez; Llorca, Javier; Dierssen-Soto, T.

doi:10.1016/j.redare.2018.06.008

Cited by 1 publication

(1 citation statement)

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“…Studies looking at the intensive care unit (ICU) population as a whole without a specific diagnosis of sepsis show mixed results, while few studies did not find any difference in terms of mortality, acute kidney injury, and rates of renal replacement therapy requirement between normal saline and balanced crystalloid [49,50], a meta-analysis done by Gonzalez et al, looking at 20,684 ICU patients, showed significantly increased rates of mortality with normal saline when compared to balanced crystalloids [51]. It is noted that the use of normal saline or plasma-lyte had no effect on gastrointestinal tolerance, which is defined as having high gastric residual volume (GRV), diarrhea, or even vomiting, in mechanically ventilated patients who were on nasogastric feeds in the ICU [52].…”

Section: Role In Critically Ill Patients (Sirs/sepsis and Icu Patients)mentioning

confidence: 99%

Crystalloid Solutions in Hospital: A Review of Existing Literature

Panchal¹,

Sivasubramanian²,

Venkata³

2023

Cureus

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Intravenous fluids (IVF) like normal saline (NS) and Ringer's lactate (RL) are often crucial in the management of hospitalized patients. Mishandling these fluids can lead to complications in about 20% of patients receiving them. In this review, we present the current evidence through the identification of observational studies and randomized trials that observed the optimal use of IVF. We found that NS may cause hyperchloremic metabolic acidosis in surgical patients, but there is no clear difference in mortality and long-term outcomes between NS and balanced crystalloids. Critically ill patients, particularly those in sepsis, benefit from balanced crystalloids, as high chloride content fluids like NS increase the risk of complications and mortality. In pancreatitis, NS has been shown to increase the risk of ICU admission when compared to RL; however, there is no significant difference in long-term outcomes and mortality between the fluids. RL is preferred for burns due to its isotonicity and lack of protein, preventing edema formation in an already dehydrated state. Plasma-lyte may resolve diabetic ketoacidosis faster, while prolonged NS use can lead to metabolic acidosis, acute kidney injury, and cerebral edema. In conclusion, NS, RL, and plasmalyte are the most commonly used isotonic IVF in the hospital population. Incorrect choice of fluids in a different clinical scenario can lead to worse outcomes.

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