TY - JOUR
T1 - Balanced versus isotonic saline resuscitation-A systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units
AU - Neto, Ary Serpa
AU - Loeches, Ignacio Martin
AU - Klanderman, Robert B.
AU - Silva, Raphael Freitas
AU - de Abreu, Marcelo Gama
AU - Pelosi, Paolo
AU - Schultz, Marcus J.
AU - for the PROVE Network Investigators
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - Balanced solution
KW - Chloride
KW - Fluid resuscitation
KW - Intensive care unit (ICU)
KW - Isotonic saline
KW - Meta-analysis
KW - Normal saline
KW - Operation room
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85027102605&partnerID=8YFLogxK
U2 - 10.21037/atm.2017.07.38
DO - 10.21037/atm.2017.07.38
M3 - Article
C2 - 28861420
AN - SCOPUS:85027102605
SN - 2305-5839
VL - 5
JO - Annals of Translational Medicine
JF - Annals of Translational Medicine
IS - 16
M1 - 323
ER -