|
|
|
|
|
| Comprehensive effect of balanced crystalloids or saline in critically ill patients: a Meta-analysis |
| Gong Ju, Huang Xiao-wen, Zhang Bi-bo, Li Bin, Zhang Ling |
| Department of Critical Care Medicine, Changshu Second People′s Hospital Affiliated to Yangzhou University, Changshu 215500, China |
|
|
|
|
Abstract Objective To systematically evaluate the comprehensive effect of balanced crystalloids or saline in critically ill patients. Methods The randomized controlled clinical trials (RCT) comparing balanced crystalloids or saline in critically ill patients were collected through the databases such as the PubMed database of the National Library of Medicine, Cochrane Library, CNKI, Wanfang database. The subjects were critically ill patients, and the retrieval time ranged from January 1966 to April 2018. Two reviewers independently screened the studies according to the inclusive and exclusive criteria, extracted the data, and assessed the quality. Then RevMan 5.3 software was used for Meta-analysis. Results In the 160 documents obtained from preliminary screening, a total of 4 studies involving 19 105 patients were enrolled after excluding duplicated documents and literature did not meet the inclusion criteria, with 9647 patients in balanced crystalloids group, and 9458 in saline group. Meta-analysis showed that there was no significant difference in ICU mortality rate between the two groups (RR 0.91, 95%CI0.82～1.01, P=0.09), no statistical difference was found in the rate of RRT therapy (RR1.03, 95%CI0.61～1.75, P=0.91), no statistical difference was found in the rate of AKI stage II or greater (RR0.93, 95%CI0.85～1.01, P=0.07), no statistical difference was found in the hospital mortality before 30 days(RR 0.93,95%CI0.85～1.01,P=0.08) or 60 days(RR0.94,95%CI0.87～1.02,P=0.13) . Conclusion In critically ill patients, compared with saline, balanced crystalloids couldn′t decrease the ICU mortality, rate of RRT therapy, rate of AKI stage II or greater.
|
|
|
|
Corresponding Authors:
Huang Xiao-wen, E-mail: tcmhuang@sina.com
|
|
|
|
| ［1］Finfer S, Liu B, Taylor C, et al. Resuscitation fluid use in critically ill adults:an international cross-sectional study in 391 intensive care units［J］. Crit Care, 2010,14(5):R185.
［2］Li H, Sun SR, Yap JQ, et al. 0.9% saline is neither normal nor physiological［J］. J Zhejiang Univ Sci B, 2016, 17(3):181-187.
［3］Yunos NM, Bellomo R, Glassford N, et al. Chloride-liberal vs chloride-restrictive intravenous fluid administration and acute kidney injury: an extended analysis［J］.Intensive Care Med, 2015, 41(2):257-264.
［4］Raghunathan K, Shaw A, Nathanson B, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis［J］. Crit Care Med, 2014, 42(7):1585-1591.
［5］Hammond NE, Taylor C, Finfer S, et al. Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: an international cross-sectional study［J］. PLoS One, 2017, 12(5): e0 176 292.
［6］Young P, Bailey M, Beasley R, et al. Effect of a buffered crystalloid solution vs. saline on acute kidney injury among patients in the intensive care unit: the SPLIT Randomized Clinical Trial［J］. JAMA, 2015, 314 : 1701 1710.
［7］Verma B, Luethi N, Cioccari L, et al. A multicentre randomised controlled pilot study of fluid resuscitation with saline or Plasma-Lyte 148 in critically ill patients［J］. Crit Care Resusc, 2016, 18(3):205-212.
［8］Semler MW,Wanderer JP, Ehrenfeld JM,et al. Balanced crystalloids versus saline in the intensive care unit. The SALT randomized trial［J］. Am J Respir Crit Care Med, 2017,195(10):1362-1372.
［9］Semler MW, Self WH, Rice TW, et al. Balanced crystalloids versus saline in crtitically ill adults［J］. N Engl J Med, 2018, 378(9):829-839.
［10］Kellum JA, Bellomo R, Kramer DJ, et al. Etiology of metabolic acidosis during saline resuscitation in endotoxemia［J］.Shock, 1998, 9(5): 364-368.
［11］Zhou F, Peng ZY, Bishop JV, et al. Effects of fluid resuscitation with 0.9% saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis［J］. Crit Care Med, 2014, 42(4): e270-e278.［12］Kellum JA, Song M, Venkataraman R. Effects of hyperchloremic acidosis on arterial pressure and circulating inflammatory molecules in experimental sepsis［J］.Chest, 2004, 125(1): 243-248.
［13］Kellum JA. Fluid resuscitation and hyperchloremic acidosis in experimental sepsis:improved short-term survival and acidbase balance with Hextend compared with saline［J］. Crit Care Med, 2002, 30(2): 300-305.
［14］Langer T,Santini A, Scotti E, et al. Intravenous balanced solutions: from physiology to clinical evidence［J］. Anaesthesiol Intensive Ther, 2015, 9:s78-88.
［15］Krajewski ML, Raghunathan K, Paluszkiewicz SM, et al. Meta-analysis of high-versus low-chloride content in perioperative and critical care fluid resuscitation［J］. Br J Surg, 2015, 102(1): 24-36.
［16］Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults［J］. JAMA, 2012, 308(15): 1566-1572.
［17］Sen A, Keener CM, Sileanu FE, et al. Chloride content of fluids used for large volume resuscitation is associated with reduced survival［J］. Crit Care Med, 2017, 45(2): e146-e153.
［18］Vincent JL, De Backer D. Saline versus balanced solutions: are clinical trials comparing two crystalloid solutions really needed［J］. Crit Care, 2016, 20(1):250. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
