Saline Versus Plasma-Lyte A in Initial Resuscitation of Trauma Patients

Young, Jessica L; Utter, Garth H.; Schermer, Carol R.; Galante, Joseph M.; Phan, Ho H.; Yang, Yifan; Anderson, Brock A.; Scherer, Lynette A.

doi:10.1097/sla.0b013e318295feba

Cited by 208 publications

(175 citation statements)

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“…Fifty-eight articles were excluded after full text review due to following reasons: included colloid or other solutions in one of the trial arms (n=32); reviews (n=10); trials conducted exclusively in EDs (n=4); not an RCT (n=5); involving healthy volunteers (n=3), RCT in pediatric patients (n=2), RCT in a nonhuman setting (n=1) and article retracted (n=1). Finally, 11 RCTs (2,703 participants) were included in the final analysis ( Figure 1) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The composition of the balanced solutions tested in each RCT is shown in Table S2.…”

Section: Search Resultsmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Search Resultsmentioning

confidence: 99%

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

et al. 2017

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“…Indeed, several clinical trials, even designed as prospective and randomized studies [54,55], had been conducted aimed at comparing several physiological effects of the two categories of intravenous solutions, whereas the scientific community still needed an understanding of whether such physiological effects (i.e. on acid-base equilibrium, on renal function and other organs) translated into a survival difference (Table 4).…”

Section: Clinical Evidencementioning

confidence: 99%

Intravenous balanced solutions: from physiology to clinical evidence

Länger

Santini

Scotti

et al. 2015

Anaesthesiol Intensive Ther

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Abstract"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental alteration of renal function associated with hyperchloremia. Despite efforts made towards its identification, the ideal balanced solution, with minimal effects on acid-base status, low chloride content, and adequate tonicity, is not yet available. After the accumulation of pre-clinical and clinical physiologic data, in the last three years, several clinical trials, mostly observational and retrospective, have addressed the question of whether the use of balanced solutions has beneficial effects as compared to the standard of care, sometimes even suggesting an improvement in survival. Nonetheless, the first large randomized controlled trial comparing the effects of a balanced vs. unbalanced solutions on renal function in critically-ill patients (SPLIT trial, the 0.9% saline vs. Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy), just recently published, showed identical equipoise between the two treatments. In the present review, we offer a comprehensive and updated summary on this issue, firstly, by providing a full physiological background of balanced solutions; secondly, by summarizing their potential pathophysiologic effects; and lastly, by presenting the clinical evidence available to support their use at the present time.

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“…In experimental studies NS was found to cause electrolyte disturbances (hypernatraemia, hyperchloraemia) and metabolic acidosis (due to SID of 0 mEq/L), with its clinical sequelae of impaired kidney function, coagulation abnormalities, and inflammatory response [11]. Plasma-Lyte A as a calcium-free balanced crystalloid solution has been shown to produce lesser metabolic derangements in the population of trauma patients [12]. Zhou et al [13], in an experimental model of abdominal sepsis in rats, showed lesser metabolic acidosis and lower chloride concentration with Pasma-Lyte compared to NS.…”

Section: Discussionmentioning

confidence: 99%

Does fluid resuscitation with balanced solutions induce electrolyte and metabolic abnormalities? An in vitro assessment

Krzych

Czempik

2017

Kardiol Pol

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A b s t r a c tBackground: Popular intravenous fluids in clinical use may have an impact on electrolyte concentration and metabolic balance and should be considered as powerful pharmacological agents. There is a growing body of evidence that fluid therapy should be more individualised and preferably based on balanced solutions. Aim:We sought to investigate the impact of three commonly used balanced fluids on electrolytes and metabolic equilibrium in an in vitro setting. Methods:Study group comprised 32 healthy male volunteers (without history of any acute/chronic disorder or known metabolic abnormality), aged 21-35 (29 ± 4) years, weight 59-103 (81.2 ± 9.8) kg, from whom blood samples were withdrawn. The whole blood was diluted in 4:1 ratio with the study solutions to make an end-concentration of 20 vol.% of each solution. The test solutions included balanced crystalloid (Plasmalyte All test solutions caused a similar statistically significant (p < 0.05) drop in base excess and bicarbonate concentration, and these fell outside the reference values. Due to its composition, GEL caused a significant increase in lactate concentration. HES and GEL caused a statistically significant drop in strong ion difference value. Due to high lactate level, the effect of GEL was most pronounced.Conclusions: Balanced intravenous solutions should be safe in terms of their impact on human plasma electrolyte and metabolic equilibrium when administered to replace up to 20% of blood volume. In metabolic acidosis, balanced succinylated gelatin should be used with caution. Therefore, arterial blood gas analysis should be performed in patients in whom significant amounts of fluid are administrated, preferably with assessment of Cl -, Na + , lactate concentrations as well as pH, osmolality, and strong ion difference.

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Saline Versus Plasma-Lyte A in Initial Resuscitation of Trauma Patients

Abstract: Compared with 0.9% NaCl, resuscitation of trauma patients with Plasma-Lyte A resulted in improved acid-base status and less hyperchloremia at 24 hours postinjury. Further studies are warranted to evaluate whether resuscitation with Plasma-Lyte A improves clinical outcomes.

Cited by 208 publications

References 24 publications

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

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

Intravenous balanced solutions: from physiology to clinical evidence

Does fluid resuscitation with balanced solutions induce electrolyte and metabolic abnormalities? An in vitro assessment

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