Abstract
ObjectivesIntravenous fluids are one of the most used medical therapy for patients, especially critically ill patients. We conducted a meta-analysis comparing between balanced crystalloids and normal saline in critically ill patients and its effect on various clinical outcomes.DesignMeta-analysis and systematic review of randomized clinical trials (RCTs).Methods and data sourceElectronic search was performed using PubMed, Cochrane library, and clinical trials.gov from inception through March 1, 2018, with inclusion of prospective studies that investigated one of the primary outcomes which were acute kidney injury (AKI) and in-hospital mortality while secondary outcomes were intensive care unit (ICU) mortality and new renal replacement therapy (RRT).ResultsSix RCTs were included. Total of 19,332 patients were included in the final analysis. There was no significant difference in in-hospital mortality (11.5% vs 12.2%; OR 0.92; 95% CI 0.85–1.01; P = 0.09; I2 = 0%), incidence of AKI (12% vs 12.7%, OR 0.92; 95% CI 0.84–1.01; P = 0.1; I2 = 0), overall ICU mortality (OR 0.9, 95% CI 0.81–1.01, P = 0.08, I2 = 0%), or need for new RRT (OR 0.92, 95% CI 0.67–1.28, P = 0.65, I2 = 38%) between balanced crystalloids and isotonic saline in critically ill patients.ConclusionBalanced crystalloids and isotonic saline have no difference on various clinical outcomes including in-hospital mortality, AKI, overall ICU mortality, and new RRT. Further powerful clinical trials are required to determine the relationship between crystalloid fluid type and clinical outcomes.
Highlights
Intravenous fluids are one of the most commonly used medical therapies for patients especially in intensive care units (ICUs)
There was no significant difference in in-hospital mortality (11.5% vs 12.2%; odds ratios (OR) 0.92; 95% Confidence interval (CI) 0.85–1.01; P = 0.09; I2 = 0%), incidence of acute kidney injury (AKI) (12% vs 12.7%, OR 0.92; 95% confidence intervals (95% CI) 0.84–1.01; P = 0.1; I2 = 0), overall ICU mortality, or need for new renal replacement therapy (RRT) between balanced crystalloids and isotonic saline in critically ill patients
Balanced crystalloids and isotonic saline have no difference on various clinical outcomes including in-hospital mortality, AKI, overall ICU mortality, and new RRT
Summary
Intravenous fluids are one of the most commonly used medical therapies for patients especially in intensive care units (ICUs). Isotonic saline has been the most commonly used crystalloid for fluid resuscitation [1, 2]. The balanced crystalloids like lactated Ringer’s and Plasma-Lyte solutions have an electrolyte composition which is closer to plasma. In a prospective study in critically ill patients, chloride-restrictive fluid strategy was associated with decreased incidence of AKI and need for new renal replacement therapy (RRT) when compared to rich. Zayed et al Journal of Intensive Care (2018) 6:51 chloride fluids [3]. Resuscitation with Plasma-Lyte solution at the day of surgery was associated with a decrease in rate of major complications including new RRT, incidence of infections, and blood transfusion in comparison to isotonic saline in a retrospective matched observational study [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
