Effects of balanced solution on short-term outcomes in traumatic brain injury
            patients: a secondary analysis of the BaSICS randomized trial

Zampieri, Fernando G.; Damiani, Lucas Petri; Biondi, Rodrigo Santos; Freitas, Flávio Geraldo Rezende; Veiga, Viviane Cordeiro; Figueiredo, Rodrigo Cruvinel; Neto, Ary Serpa; Manoel, Airton Leonardo de Oliveira; Miranda, Tamiris Abait; Corrêa, Thiago Domingos; Azevedo, Luciano César Pontes; Silva, Nilton Brandão da; Machado, Flávia Ribeiro; Cavalcanti, Alexandre Biasi; BRICNet, BRICNet

doi:10.5935/0103-507x.20220261-en

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Another drawback of this study was that they did not delineate the type of head injury, which in itself plays an important role in influencing patient outcomes. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma – A randomised controlled trial

Sakkanan,

Swaminathan,

Bidkar

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: The choice of intravenous fluids is important in patients with traumatic brain injury (TBI), where large volumes may be required for resuscitation. Our study aimed to compare 0.9% normal saline (NS) with balanced crystalloid (Plasmalyte) in TBI patients in terms of metabolic and coagulation profile, brain relaxation score (BRS) and renal functions using serum urea, creatinine and urinary tissue inhibitor of metalloproteinases-2* insulin-like growth factor binding protein-7, [TIMP-2]*[IGFBP7], value to assess the risk of acute kidney injury. Methods: This randomised controlled trial on 90 TBI patients undergoing emergency craniotomy and subdural haematoma evacuation was conducted in a tertiary care institute. The patients were randomised to receive either NS (Group NS) or Plasmalyte (Group P) as the intraoperative maintenance fluid. The primary outcome measures included the potential of hydrogen (pH), base excess (BE) and chloride values from an arterial blood gas. The secondary outcomes were the coagulation profile, BRS and urinary [TIMP-2]*[IGFBP7]. The two groups’ metabolic profile differences were analysed using two-way repeated analysis of variance. BRS was analysed using the Mann–Whitney U test. A P value < 0.05 was considered to be statistically significant. Results: The pH and chloride values were significantly higher, and the BE values were significantly lower in Group P compared to Group NS (P < 0.001). Brain relaxation and coagulation profiles were comparable between the two groups. Serum creatinine (P = 0.002) and urinary [TIMP-2]*[IGFBP7] (P = 0.042) were significantly higher in the NS group. Conclusion: Plasmalyte maintains a more favourable metabolic profile than NS in TBI patients without affecting brain relaxation adversely.

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“…Another drawback of this study was that they did not delineate the type of head injury, which in itself plays an important role in influencing patient outcomes. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma – A randomised controlled trial

Sakkanan,

Swaminathan,

Bidkar

et al. 2024

Indian Journal of Anaesthesia

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“…Among 6754 patients with sepsis from 5 RCTs, there was no difference in mortality between a balanced crystalloid group and a saline group (31.3% vs 33.9%; relative risk, 0.93 [95% CI, 0.86-1.01]) . In a preplanned subgroup analysis (BASICS trial), balanced crystalloids increased mortality in 483 patients with traumatic brain injury (odds ratio, 1.48; 95% credible interval, 1.04-2.09) . It is conceivable that balanced crystalloid solutions attain outcomes that are at least as good as for saline in patients with sepsis.…”

Section: Administration Of Fluid Therapymentioning

confidence: 99%

Fluid Therapy for Critically Ill Adults With Sepsis

Zampieri

Bagshaw

Semler

2023

JAMA

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ImportanceApproximately 20% to 30% of patients admitted to an intensive care unit have sepsis. While fluid therapy typically begins in the emergency department, intravenous fluids in the intensive care unit are an essential component of therapy for sepsis.ObservationsFor patients with sepsis, intravenous fluid can increase cardiac output and blood pressure, maintain or increase intravascular fluid volume, and deliver medications. Fluid therapy can be conceptualized as 4 overlapping phases from early illness through resolution of sepsis: resuscitation (rapid fluid administered to restore perfusion); optimization (the risks and benefits of additional fluids to treat shock and ensure organ perfusion are evaluated); stabilization (fluid therapy is used only when there is a signal of fluid responsiveness); and evacuation (excess fluid accumulated during treatment of critical illness is eliminated). Among 3723 patients with sepsis who received 1 to 2 L of fluid, 3 randomized clinical trials (RCTs) reported that goal-directed therapy administering fluid boluses to attain a central venous pressure of 8 to 12 mm Hg, vasopressors to attain a mean arterial blood pressure of 65 to 90 mm Hg, and red blood cell transfusions or inotropes to attain a central venous oxygen saturation of at least 70% did not decrease mortality compared with unstructured clinical care (24.9% vs 25.4%; P = .68). Among 1563 patients with sepsis and hypotension who received 1 L of fluid, an RCT reported that favoring vasopressor treatment did not improve mortality compared with further fluid administration (14.0% vs 14.9%; P = .61). Another RCT reported that among 1554 patients in the intensive care unit with septic shock treated with at least 1 L of fluid compared with more liberal fluid administration, restricting fluid administration in the absence of severe hypoperfusion did not reduce mortality (42.3% vs 42.1%; P = .96). An RCT of 1000 patients with acute respiratory distress during the evacuation phase reported that limiting fluid administration and administering diuretics improved the number of days alive without mechanical ventilation compared with fluid treatment to attain higher intracardiac pressure (14.6 vs 12.1 days; P &lt; .001), and it reported that hydroxyethyl starch significantly increased the incidence of kidney replacement therapy compared with saline (7.0% vs 5.8%; P = .04), Ringer lactate, or Ringer acetate.Conclusions and RelevanceFluids are an important component of treating patients who are critically ill with sepsis. Although optimal fluid management in patients with sepsis remains uncertain, clinicians should consider the risks and benefits of fluid administration in each phase of critical illness, avoid use of hydroxyethyl starch, and facilitate fluid removal for patients recovering from acute respiratory distress syndrome.

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Intravenous maintenance fluid therapy in acutely and critically ill children: state of the evidence

Brossier,

Goyer,

Verbruggen

et al. 2024

The Lancet Child & Adolescent Health

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Effects of balanced solution on short-term outcomes in traumatic brain injury patients: a secondary analysis of the BaSICS randomized trial

Cited by 3 publications

References 18 publications

Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma – A randomised controlled trial

Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma – A randomised controlled trial

Fluid Therapy for Critically Ill Adults With Sepsis

Intravenous maintenance fluid therapy in acutely and critically ill children: state of the evidence

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