No abstract

BackgroundIntravenous (IV) fluid therapy has become a ubiquitous intervention in everyday clinical practice. Several types of fluid are available including isotonic crystalloid fluids. Among crystalloid fluids, buffered solutions (derivatives of the original Hartmann's and Ringer's solutions) are increasingly recommended as first‐line resuscitation fluids. However, the choice between different buffered solutions appears to be difficult with limited data to support the use of lactate vs. acetate buffered solutions. Accordingly, we aim at systematically describing the body of evidence on the use of the different types of buffered crystalloid solutions in hospitalised patients.MethodsWe will conduct a scoping review of all study designs (i.e. no study design will per se be excluded from the proposed review) in accordance with the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) statement.ResultsWe will provide descriptive analysis of the included studies/trials, i.e. no meta‐analyses will be conducted. We will include studies on adult hospitalised patients receiving IV fluid for any reason. Studies must compare any crystalloid solution primarily buffered with lactate versus any primarily acetate buffered solution. All outcome measures will be reported. The quality of evidence will be assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.ConclusionThis outlined scoping review will provide a summary of the current body of evidence on the use, effects and side‐effects of buffered crystalloid solutions. This will provide an important update of the current evidence on the use, of “buffered” crystalloid solutions including evidence of potential benefits and harms.

| Description of the conditionCritically ill children and adults are at risk of stress-related gastrointestinal (GI) mucosal damage. 1-3 This damage may progress into GI ulcerations, which in adults have been reported to increase morbidity and mortality. 4 Through the last 25 years the incidence of stressrelated GI ulcerations has dropped with present incidences in adult intensive care unit (ICU) patients in the area of 2%-5%. 5-7 The reported incidence of GI ulcerations in pediatric ICU (PICU) patients ranges from 0.4% to 5%, 1,8-11 with likely even higher incidences in neonatal ICUs (NICUs). 12 Suggested risk factors for the development of GI bleeding in the PICU and NICU include mechanical ventilation and coagulopathy. 8,10,12 Furthermore, a correlation between the severity of illness and upper GI bleeding events in children has been proposed. 13 | Description of the interventionIn order to prevent the potential progression from stress-related mucosal damage to GI bleeding, stress ulcer prophylaxis (SUP) was introduced more than four decades ago. 14 Initially, antacids and later sucralfate were the preferred agents. The introduction of histamine-2-receptor antagonists (H2RAs) made intravenous administration possible, and a randomized clinical trial (RCT) in adult ICU patients reported a lower incidence of GI bleeding