Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis

The Annals of Pharmacotherapy
Drayton A HammondRobert A Balk

Abstract

Background: The optimal resuscitative fluid remains controversial. Objective: To assess the association between crystalloid fluid and outcomes in critically ill adults. Methods: Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, and Cochrane Central Register for Controlled Trials were searched from inception through July 2019. Cohort studies and randomized trials of critically ill adults provided predominantly nonperioperative fluid resuscitation with balanced crystalloids or 0.9% sodium chloride (saline) were included. Results: Thirteen studies (n = 30 950) were included. Balanced crystalloids demonstrated lower hospital or 28-/30-day mortality (risk ratio [RR] = 0.86; 95% CI = 0.75-0.99; I2 = 82%) overall, in observational studies (RR = 0.64; 95% CI = 0.41-0.99; I2 = 63%), and approached significance in randomized trials (RR = 0.94; 95% CI = 0.88-1.02; I2 = 0%). New acute kidney injury occurred less frequently with balanced crystalloids (RR = 0.91; 95% CI = 0.85-0.98; I2 = 0%), though progression to renal replacement therapy was similar (RR = 0.91; 95% CI = 0.79-1.04; I2 = 38%). In the sepsis cohort, odds of hospital or 28-/30-day mortality were similar, but the odds of major adverse kidney events occur...Continue Reading

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Citations

Oct 28, 2019·Internal and Emergency Medicine·Giuseppe RegolistiEnrico Fiaccadori
Jan 24, 2020·American Journal of Respiratory and Critical Care Medicine·Drayton A HammondMegan A Rech
Nov 13, 2019·Indian Journal of Pediatrics·Jean-Philippe Roy, Prasad Devarajan
Dec 11, 2020·Perioperative Medicine·David AstapenkoVladimir Cerny
Mar 2, 2021·Intensive Care Medicine Experimental·Ishaq LatUNKNOWN Research Committee of the Surviving Sepsis Campaign
Mar 19, 2021·Critical Care Medicine·Ishaq LatUNKNOWN Research Committee of the Surviving Sepsis Campaign and Members of the Surviving Sepsis Campaign Research Committee contribu
Apr 24, 2021·Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS·Jan JedlickaDaniel Chappell
Apr 24, 2021·Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS·Matthias Grünewald, Matthias Heringlake
May 28, 2021·Journal of Hepatology·William BernalPhilippe Meersseman
Sep 5, 2021·European Journal of Applied Physiology·Hanmo LiShailesh Bihari

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Methods Mentioned

BETA
Pharmacotherapy

Software Mentioned

Scopus
Cochrane Risk Assessment Tool
Revman

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