Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial

Lima, Maurício Andrade de; Neville, Iuri Santana; Cavalheiro, Sérgio; Bourguignon, Dafne C; Pelosi, Paolo; Malbouisson, Luíz Marcelo Sá

doi:10.1097/ana.0000000000000515

Cited by 29 publications

(18 citation statements)

References 33 publications

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“…47 For the purpose of resuscitation, hypotonic solutions should not be used due to the risk of further hyponatremia and subsequent cerebral edema. 1 Considering the previously mentioned, the use of HSS in the TBI context would help in the modulation of the inflammatory response and reduce the risk of brain swelling or edema that could lead to high ICP, and even lead to fatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…It is the preferred agent due to its very low propensity to cause intravenous fluid related cerebral edema. 1,27 When used in hyperosmolar concentrations (3% or more), it exerts its ICP lowering effect, mostly caused by an osmotic gradient that produces a shift of free water from the interstitial and intracellular spaces to the intravascular space. 11,12,22,33 This reduction in tissue fluid by the immediate hyperosmolar effect leads to a reduction in ICP.…”

Section: Intracranial Pressure and Physiological Effects Of Hypertonimentioning

confidence: 99%

“…Compared with the colloid solutions, crystalloids better mimic the plasma characteristics and are associated with reduced incidences of alterations in electrolyte and pH balances. 1,2 Crystalloid solutions have always been the preferred first-line agent in the fluid resuscitation for shock patients. [3][4][5][6][7][8][9][10][11] They have recently become the preferred agents for osmotherapy for neurotrauma patients 12,13 due to their ability to modulate the inflammatory reaction in the neural parenchyma.…”

Section: Introductionmentioning

confidence: 99%

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Immunomodulatory Effect of Hypertonic Saline Solution in Traumatic Brain-Injured Patients and Intracranial Hypertension

Quiñones-Ossa

Shrivastava

Perdomo

et al. 2020

Indian Journal of Neurotrauma

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Traumatic brain injury (TBI) is often associated with an increase in the intracranial pressure (ICP). This increase in ICP can cross the physiological range and lead to a reduction in cerebral perfusion pressure (CPP) and the resultant cerebral blood flow (CBF). It is this reduction in the CBF that leads to the secondary damage to the neural parenchyma along with the physical axonal and neuronal damage caused by the mass effect. In certain cases, a surgical intervention may be required to either remove the mass lesion (hematoma of contusion evacuation) or provide more space to the insulted brain to expand (decompressive craniectomy). Whether or not a surgical intervention is performed, all these patients require some form of pharmaceutical antiedema agents to bring down the raised ICP. These agents have been broadly classified as colloids (e.g., mannitol, glycerol, urea) and crystalloids (e.g., hypertonic saline), and have been used since decades. Even though mannitol has been the workhorse for ICP reduction owing to its unique properties, crystalloids have been found to be the preferred agents, especially when long-term use is warranted. The safest and most widely used agent is hypertonic saline in various concentrations. Whatever be the concentration, hypertonic saline has created special interest among physicians owing to its additional property of immunomodulation and neuroprotection. In this review, we summarize and understand the various mechanism by which hypertonic saline exerts its immunomodulatory effects that helps in neuroprotection after TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Intracranial Pressure and Physiological Effects Of Hypertonimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Immunomodulatory Effect of Hypertonic Saline Solution in Traumatic Brain-Injured Patients and Intracranial Hypertension

Quiñones-Ossa

Shrivastava

Perdomo

et al. 2020

Indian Journal of Neurotrauma

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“…Observou-se ainda que as soluções balanceadas apresentam perfil mais seguro de eletrólitos e ácido-base quando comparado à salina 0,9%. Não houve variações da pressão intracranina e/ou da avaliação do edema cerebral pelo cirurgião 19 .…”

Section: Pediatriaunclassified

Comparação Entre Solução Salina 0,9% E Cristaloides Balanceados: Revisão Bibliográfica

Silva¹,

Costa

2020

J Surg Cl Res

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Um marco importante na medicina foi o desenvolvimento dos fluidos intravenosos. Obteve-se impacto imediato nos desfechos de doenças, como a cólera, e nos pacientes politraumatizados. Sua importância desencadeou um interesse pelo estudo da fisiologia e anatomia da macro e microcirculação, criação de novos fluidos, bem como o impacto do tipo das soluções sobre os desfechos clínicos. A solução salina, popularizada como solução fisiológica ou normal, é uma das soluções mais antigas e mais utilizadas no mundo. As soluções balanceadas, como o Plasma-lyte®, Ringer Lactato, entre outros, que utilizam tampões e ânions fracos na composição, começaram a ser apresentadas e se mostraram mais fisiológicas e com desfechos clínicos melhores em uma variedade extensa de pacientes. As descobertas da anatomia e fisiologia da microcirculação, alterações hidroeletrolíticas e ácido-básicas específicas de cada doença, hipercloremia e seus malefícios trouxeram uma discussão ampla e importante na indicação de cada cristaloide. O tipo e a quantidade de fluido a ser administrada no perioperatório têm impacto direto no desfecho dos pacientes. As soluções balanceadas vêm se apresentando como alternativa superior à solução salina 0,9% no contexto perioperatório.

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“…Allen et al observed a greater increase in serum bicarbonate and more rapid improvement in dehydration scores [ 16 ] with CSL compared to NS. Balanced solution in perioperative IVFT in children undergoing brain tumour resection was associated with a lower incidence of chloride increase [ 17 ]. Balamuth et al recently reported on a pilot feasibility RCT in children with sepsis comparing CSL and NS, but the study was not powered for clinical outcomes [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

0.9% Sodium chloride solution versus Plasma-Lyte 148 versus compound sodium lacTate solution in children admitted to PICU—a randomized controlled trial (SPLYT-P): study protocol for an intravenous fluid therapy trial

Raman

Schibler

Marsney

et al. 2021

Trials

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Background Intravenous fluid therapy represents the most common intervention critically ill patients are exposed to. Hyperchloremia and metabolic acidosis associated with 0.9% sodium chloride have been observed to lead to worse outcomes, including mortality. Balanced solutions, such as Plasma-Lyte 148 and Compound Sodium Lactate, represent potential alternatives but the evidence on optimal fluid choices in critically ill children remains scarce. This study aims to demonstrate whether balanced solutions, when used as intravenous fluid therapy, are able to reduce the incidence of a rise in serum chloride level compared to 0.9% sodium chloride in critically ill children. Methods This is a single-centre, open-label randomized controlled trial with parallel 1:1:1 assignment into three groups: 0.9% sodium chloride, Plasma-Lyte 148, and Compound Sodium Lactate solutions for intravenous fluid therapy. The intervention includes both maintenance and bolus fluid therapy. Children aged < 16 years admitted to intensive care and receiving intravenous fluid therapy during the first 4 h of admission are eligible. The primary outcome measure is a ≥ 5mmol/L increase in serum chloride level within 48 h post-randomization. The enrolment target is 480 patients. The main analyses will be intention-to-treat. Discussion This study tests three types of intravenous fluid therapy in order to compare the risk of hyperchloremia associated with normal saline versus balanced solutions. This pragmatic study is thereby assessing the most common intervention in paediatric critical care. This is a single-centre open-label study with no blinding at the level of delivery of the intervention. Certain paediatric intensive care unit (PICU) patient groups such as those admitted with a cardiac condition or following a traumatic brain injury are excluded from this study. Trial registration The study has received ethical approval (HREC/19/QCHQ/53177: 06/06/2019). It is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619001244190) from 9th September 2019. Recruitment commenced on 12th November 2019. The primary results manuscript will be published in a peer-reviewed journal.

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Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial

Abstract: In children undergoing brain tumor resection, saline infusion increased variation in serum chloride compared with balanced crystalloid. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection.

Cited by 29 publications

References 33 publications

Immunomodulatory Effect of Hypertonic Saline Solution in Traumatic Brain-Injured Patients and Intracranial Hypertension

Immunomodulatory Effect of Hypertonic Saline Solution in Traumatic Brain-Injured Patients and Intracranial Hypertension

Comparação Entre Solução Salina 0,9% E Cristaloides Balanceados: Revisão Bibliográfica

0.9% Sodium chloride solution versus Plasma-Lyte 148 versus compound sodium lacTate solution in children admitted to PICU—a randomized controlled trial (SPLYT-P): study protocol for an intravenous fluid therapy trial

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