Comparison of Balanced Crystalloid Solutions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Curran, Jeffrey; Major, Paityn; Tang, Kent; Bagshaw, Sean M.; Dionne, Joanna C.; Menon, Kusum; Rochwerg, Bram

doi:10.1097/cce.0000000000000398

Cited by 13 publications

(9 citation statements)

References 40 publications

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“…One o the conclusion was the Plasmalyte determines the lowest increase in chloride concentration in plasma after infusion (mean difference 0,83 mmol/L, 95%CI 0,03 to 1,64 mmol/L) and the lowest increase in serum lactate (mean difference 0,46 mmol/L, 95% CI 0,05 to 0,87 mmol/L) compared to any other balanced crystalloid. No statistically significant differences were reported for the serum potassium levels or the pH values for the solutions included in the study [49].…”

Section: Updates -In Fluid Resuscitation Formulasmentioning

confidence: 88%

Update on Current Concepts in Management of Severe Hemorrhagic Shock and Optimal Individualized Fluid Therapy in Critically Ill Polytrauma Patients

Rogobete¹,

Ritiu²,

Bedreag³

et al. 2022

Preprint

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Worldwide, one of the main causes of death among young adults is multiple trauma. In these pa-tients hemorrhagic shock represents the leading cause for worsening of the clinical status and for increased morbidity and mortality. This is due to a multifactorial complex involving cellular, bi-ological, and biophysical mechanisms. The most important mechanisms affecting clinical out-come are oxidative stress, the augmentation of pro-inflammatory status, immune deficiency, dis-ruptions in the coagulation cascade, imbalances in electrolyte and acid-base homeostasis. Poly-trauma patients in hemorrhagic shock need adequate fluid management to ensure hemodynamic stability that must consider not only the maintenance of adequate blood pressure, but also the ad-equate oxygenation of tissues for optimal cellular function. In the current clinical practice, fluid resuscitation in polytrauma patients uses a variety of widely studied pharmacological products, such as crystalloids, colloids, blood transfusions, and the infusion of other blood products. Alt-hough these products exist, an agreement was not reached on a standard administration protocol that could be generally applied for all patients. Moreover, numerous studies have reported a se-ries of adverse events related to fluid resuscitation and to the inadequate use of these products. This review aims at describing the impact the administration of all the solutions used in fluid re-suscitation might have on the cellular and pathophysiological mechanisms in the case of poly-trauma patients suffering from hemorrhagic shock.

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Section: Updates -In Fluid Resuscitation Formulasmentioning

confidence: 88%

Update on Current Concepts in Management of Severe Hemorrhagic Shock and Optimal Individualized Fluid Therapy in Critically Ill Polytrauma Patients

Rogobete¹,

Ritiu²,

Bedreag³

et al. 2022

Preprint

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“…Although LR generally does not decrease the lactate clearance, the persistence of hyperlactatemia during the first 24 h with a high L/P (lactate/pyruvate) ratio is still associated with a risk of multi-organ failure and death in clinical septic shock ( 18 ). The recommended solution is rather the acetate-based Plasma-Lyte solution ( 17 , 19 ). Nevertheless, in a case report, an AR infusion of sufficient quantity induced lactic acidosis but did not cause any adverse effects ( 20 ).…”

Section: Non-optimality Of Current Fluidsmentioning

confidence: 99%

Pyruvate as a Potential Beneficial Anion in Resuscitation Fluids

Zhou

2022

Front. Med.

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There have been ongoing debates about resuscitation fluids because each of the current fluids has its own disadvantages. The debates essentially reflect an embarrassing clinical status quo that all fluids are not quite ideal in most clinical settings. Therefore, a novel fluid that overcomes the limitations of most fluids is necessary for most patients, particularly diabetic and older patients. Pyruvate is a natural potent antioxidant/nitrosative and anti-inflammatory agent. Exogenous pyruvate as an alkalizer can increase cellular hypoxia and anoxia tolerance with the preservation of classic glycolytic pathways and the reactivation of pyruvate dehydrogenase activity to promote oxidative metabolism and reverse the Warburg effect, robustly preventing and treating hypoxic lactic acidosis, which is one of the fatal complications in critically ill patients. In animal studies and clinical reports, pyruvate has been shown to play a protective role in multi-organ functions, especially the heart, brain, kidney, and intestine, demonstrating a great potential to improve patient survival. Pyruvate-enriched fluids including crystalloids and colloids and oral rehydration solution (ORS) may be ideal due to the unique beneficial properties of pyruvate relative to anions in contemporary existing fluids, such as acetate, bicarbonate, chloride, citrate, lactate, and even malate. Preclinical studies have demonstrated that pyruvate-enriched saline is superior to 0.9% sodium chloride. Moreover, pyruvate-enriched Ringer’s solution is advantageous over lactated Ringer’s solution. Furthermore, pyruvate as a carrier in colloids, such as hydroxyethyl starch 130/0.4, is more beneficial than its commercial counterparts. Similarly, pyruvate-enriched ORS is more favorable than WHO-ORS in organ protection and shock resuscitation. It is critical that attention first be paid to improving abnormal saline with pyruvate for ICU patients. Many clinical trials with a high dose of intravenous or oral pyruvate were conducted over the past half century, and results indicated its effectiveness and safety in humans. The long-term instability of pyruvate aqueous solutions and para-pyruvate cytotoxicity is not a barrier to the pharmaceutical manufacturing of pyruvate-enriched fluids for ICU patients. Clinical trials with sodium pyruvate-enriched solutions are urgently warranted.

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“…Several RCTs and reviews hereof have compared buffered solutions with normal saline without distinctively assessing the different types of buffered solutions. [41][42][43][44][45][46] A review by Curran et al 47 assessed the use of different types of buffered crystalloid solutions based on F I G U R E 4 Forrest plot of hospital length of stay (random-effect model) manufactural origin rather than on their buffering agent. They concluded that data on patient-important outcomes were too sparse and heterogeneous to allow for pooling, which is in line with our results.…”

Section: Relation To Current Evidencementioning

confidence: 99%

Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis

Ellekjær

Perner

Sivapalan

et al. 2022

Acta Anaesthesiol Scand

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Objective: There is a widespread use of buffered crystalloid solutions in clinical practice. However, guidelines do not distinguish between specific types of buffered solutions and clinical equipoise exists. We aimed to assess the desirable and undesirable effects of acetate-versus lactate-buffered solutions in hospitalised patients.Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials assessing the use of acetate-versus lactatebuffered solutions for intravenous administration in hospitalised adults and children.The primary outcome was all-cause short-term mortality. We adhered to our published protocol, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Results:We included five RCTs enrolling 390 patients. We found no statistically significant difference in short-term mortality (random effects, risk ratio [RR] 0.29; 95% confidence interval [CI] 0.06-1.51, p = .14, I 2 = 0%) or hospital length of stay (LOS) (random effects, mean difference [MD]-1.31, 95% CI À3.66 to 1.05, p = .28, I 2 = 0%) between acetate-versus lactate-buffered solutions. The quality of evidence was very low. Data regarding intensive care unit LOS were reported by three trials and duration of vasopressor treatment by one trial; none of these data allowed for pooling in metaanalyses. No trials reported data on long-term mortality, health-related quality of life, adverse events, duration of mechanical ventilation or renal replacement therapy. Conclusion:In this systematic review, we found very low quantity and quality of evidence on the use of acetate-versus lactate-buffered solutions in hospitalised patients.

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Comparison of Balanced Crystalloid Solutions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract: Supplemental Digital Content is available in the text.

Cited by 13 publications

References 40 publications

Update on Current Concepts in Management of Severe Hemorrhagic Shock and Optimal Individualized Fluid Therapy in Critically Ill Polytrauma Patients

Update on Current Concepts in Management of Severe Hemorrhagic Shock and Optimal Individualized Fluid Therapy in Critically Ill Polytrauma Patients

Pyruvate as a Potential Beneficial Anion in Resuscitation Fluids

Acetate‐ versus lactate‐buffered crystalloid solutions: A systematic review with meta‐analysis and trial sequential analysis

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