Normal Saline Solution or Lactated Ringer’s Solution to Enhance Lactate Clearance in Septic Patients After Initial Resuscitation in the ED: A Retrospective Cohort Trial

Abstract

Objective: To compare the effect of isotonic crystalloid solutions between lactated Ringer's solution (LRS) and normal saline solution (NSS) on lactate clearance in septic patients at the emergency department (ED). Materials and Methods:This study is a single-center retrospective chart review. The study enrolled patients older than 18 years with sepsis and initial serum lactate level >2 mg/dL in the ED. The primary outcome was to determine which isotonic solution was better for serum lactate clearance in septic patients. The secondary outcomes were serum creatinine change within 24 h and the 48-h survival rate after admission. Results: A total of 120 patients were enrolled with a median crystalloid volume administered in the ED of 1000 mL. Within 2 h of resuscitation, there was no difference in lactate clearance between the LRS and NSS groups with median values of 29.2% and 25%, respectively (P=0.839). The 48-h survival rate after admission did not differ between the LRS and NSS groups with median values of 90% and 86%, respectively. Both isotonic solutions increased serum creatinine levels within 24 h of treatment with median values of 0.3 for each group (P=0.647). Conclusion: Among septic patients in the ED treated with NSS or LRS, there was no difference in lactate clearance, serum creatinine change within 24 h, or 48-h survival. However, several factors were associated with increased lactate levels, such as older age and use of vasopressors and immunosuppressive agents.

Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis

“…Subsequently, we excluded 21 studies because of lack of appropriate outcome or population (included non-sepsis patients), secondary paper of included study, or conference abstracts of included or excluded studies. Eventually, 15 studies [ 11 , 12 , 13 , 14 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] met our inclusion criteria and were included in the meta-analysis. Figure 1 shows the PRISMA flow chart that illustrates how the final studies were selected.…”

“…All the included studies were published between November 2013 and January 2022 and included patients with sepsis. Based on country of origin, six studies [ 24 , 27 , 28 , 29 , 30 , 33 ] originated from the USA, four studies [ 13 , 25 , 26 , 32 ] from Asia (China, India, Taiwan, and Thailand), two studies [ 14 , 23 ] from Europe (France and Italy), and two studies [ 11 , 31 ] from Australia and New Zealand, and one study [ 12 ] from Brazil. Regarding the design of studies, eight were RCTs [ 11 , 12 , 14 , 23 , 25 , 28 , 29 , 31 ] and seven [ 13 , 24 , 26 , 27 , 30 , 32 , 33 ] were retrospective cohort studies.…”

“…A total of 20,329 patients with sepsis were included. Regarding enrollment location, ten studies [ 11 , 12 , 23 , 27 , 28 , 29 , 31 , 32 , 33 ] enrolled patients in ICU, four [ 14 , 24 , 25 , 26 ] in ED, and one [ 30 ] in both ED and ICU. A total of 9752 patients received BC, while 10,577 patients received NS.…”

“…All 15 studies [ 11 , 12 , 13 , 14 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], which included 20,329 patients with sepsis, reported overall mortality (21.1% in the BC group and 25.2% in the NS group). The overall mortality rate was lower in the BC group compared to NS group (RR 0.88, 95% CI 0.81–0.96, p = 0.005, I 2 = 51%, Figure 2 A).…”

“…Quality assessment scores of the RCTs and observational studies are summarized in Supplementary Table S2 . There was a low risk of bias for all the fifteen studies [ 11 , 12 , 13 , 14 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], as shown in Supplementary Table S2 . There was a visible asymmetry in the funnel plot of studies that reported overall mortality, which may suggest the presence of publication bias ( Supplementary Figure S3 ).…”