Modified acetate Ringer's solutions versus Ringer's lactate solutions in perioperative patients: a systematic review

Abstract

Objective To systematically review published randomized controlled trials(RCTs) comparing perioperative administration of modified Ringer's acetate(PA) versus Ringer's lactate solutions (LR) in terms of effect on patient outcomes, so as to provide some evidence for volume expansion. Methods PubMed, EMBASE, Cochrane library, Web of Science, Chinese Science Citation Database(CSCD), Chinese Biomedical Literature Database (CBM) were searched to identify RCTs comparing PA and LR published between January 1996 and June 2015. Cochrane Risk of Bias Tool was applied to assess the quality of literature. The RCTs meeting the criterion of inclusion were selected for meta-analysis. Outcomes included mortality, organ failure, pH, base excess (BE), partial pressure of carbon dioxide(PaCO2), lactate concentration, and bicarbonate anion(HCO3-). Results 265 published papers were searched, from which 12 RCTs (with 664 patients) were eligible according to the inclusion criterion. Mata-analysis showed that there were no statistically significant differences between PA group and LR group in BE and HCO3; pH value in the PA group was higher than that in the LR group(P=0.04); PaCO2 was higher in the LR(P=0.013); blood lactate concentration was higher in the LR group(P=0.000). Conclusion This study showed that modified Ringer acetate solution may reduce blood lactate concentration compared with Ringer lactate solution. However, the studies included in this review were of poor quality. The evaluation and comparison of these solutions for volume expansion is subject to investigation with high-quality randomised controlled double-blind large trials. Key words: Intraoperative period; Ringer's lactate solution; Modified acetate Ringer's solutions