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

Ary Serpa Neto, Ignacio Martin Loeches, Robert B. Klanderman, Raphael Freitas Silva, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz, for the PROVE Network Investigators

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17 Citations (Scopus)


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.

Original languageEnglish
Article number323
Number of pages11
JournalAnnals of Translational Medicine
Issue number16
Publication statusPublished - 2017
Externally publishedYes


  • Balanced solution
  • Chloride
  • Fluid resuscitation
  • Intensive care unit (ICU)
  • Isotonic saline
  • Meta-analysis
  • Normal saline
  • Operation room
  • Systematic review

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