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Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis.
Ann Pharmacother. 2020 01; 54(1):5-13.AP

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 occurring in the first 30 days were less with balanced crystalloids than saline (OR = 0.78; 95% CI = 0.66-0.91; I2 = 42%). Conclusion and Relevance: Resuscitation with balanced crystalloids demonstrated lower hospital or 28-/30-day mortality compared with saline in critically ill adults but not specifically those with sepsis. Balanced crystalloids should be provided preferentially to saline in most critically ill adult patients.

Authors+Show Affiliations

Rush University Medical Center, Chicago, IL, USA.Cleveland Clinic, Cleveland, OH, USA.Loyola University Medical Center, Maywood, IL, USA.Medical University of South Carolina, Charleston, SC, USA.Rush University Medical Center, Chicago, IL, USA.Rush University Medical Center, Chicago, IL, USA.Rush University Medical Center, Chicago, IL, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31364382

Citation

Hammond, Drayton A., et al. "Balanced Crystalloids Versus Saline in Critically Ill Adults: a Systematic Review and Meta-analysis." The Annals of Pharmacotherapy, vol. 54, no. 1, 2020, pp. 5-13.
Hammond DA, Lam SW, Rech MA, et al. Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis. Ann Pharmacother. 2020;54(1):5-13.
Hammond, D. A., Lam, S. W., Rech, M. A., Smith, M. N., Westrick, J., Trivedi, A. P., & Balk, R. A. (2020). Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis. The Annals of Pharmacotherapy, 54(1), 5-13. https://doi.org/10.1177/1060028019866420
Hammond DA, et al. Balanced Crystalloids Versus Saline in Critically Ill Adults: a Systematic Review and Meta-analysis. Ann Pharmacother. 2020;54(1):5-13. PubMed PMID: 31364382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis. AU - Hammond,Drayton A, AU - Lam,Simon W, AU - Rech,Megan A, AU - Smith,Melanie N, AU - Westrick,Jennifer, AU - Trivedi,Abhaya P, AU - Balk,Robert A, Y1 - 2019/07/31/ PY - 2019/8/1/pubmed PY - 2020/7/4/medline PY - 2019/8/1/entrez KW - balanced KW - crystalloid KW - fluid KW - lactated Ringer’s KW - plasma-lyte KW - resuscitation KW - saline KW - unbalanced SP - 5 EP - 13 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 54 IS - 1 N2 - 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 occurring in the first 30 days were less with balanced crystalloids than saline (OR = 0.78; 95% CI = 0.66-0.91; I2 = 42%). Conclusion and Relevance: Resuscitation with balanced crystalloids demonstrated lower hospital or 28-/30-day mortality compared with saline in critically ill adults but not specifically those with sepsis. Balanced crystalloids should be provided preferentially to saline in most critically ill adult patients. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/31364382/Balanced_Crystalloids_Versus_Saline_in_Critically_Ill_Adults:_A_Systematic_Review_and_Meta_analysis_ L2 - https://journals.sagepub.com/doi/10.1177/1060028019866420?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -