Balanced Crystalloids vs Saline in Critically Ill Adults with Cirrhosis

2019 ◽  
Author(s):  
T.D. Coston ◽  
R.M. Brown ◽  
N.I. Krishnan ◽  
J.P. Wanderer ◽  
J.M. Ehrenfeld ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Balanced Crystalloids

Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis

2019 ◽  
Vol 54 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Drayton A. Hammond ◽  
Simon W. Lam ◽  
Megan A. Rech ◽  
Melanie N. Smith ◽  
Jennifer Westrick ◽  
...  
Keyword(s):  
Critically Ill ◽  
Observational Studies ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Cochrane Central Register ◽  
Central Register ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Balanced Crystalloids

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.

scholarly journals Balanced Crystalloids versus Saline in Critically Ill Adults

2018 ◽  
Vol 378 (9) ◽  
pp. 829-839 ◽  
Author(s):  
Matthew W. Semler ◽  
Wesley H. Self ◽  
Jonathan P. Wanderer ◽  
Jesse M. Ehrenfeld ◽  
Li Wang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Balanced Crystalloids

Balanced Crystalloids vs Saline for Critically Ill Adults

CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A1120 ◽  
Author(s):  
Matthew Semler ◽  
Wesley Self ◽  
Todd Rice
Keyword(s):  
Critically Ill ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Balanced Crystalloids
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