Abstract: FR-PO573
Use of Balanced Crystalloids vs. Isotonic Saline in Critically Ill Patients: A Meta-Analysis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders
- 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical
Authors
- Alattal, Sara, Michigan State University, East Lansing, Michigan, United States
- Khor, Si Yuan, Michigan State University, East Lansing, Michigan, United States
- Alattal, Saif Al-Deen, Michigan State University, East Lansing, Michigan, United States
- Al-Abcha, Abdullah, Michigan State University, East Lansing, Michigan, United States
- Radhakrishnan, Yeshwanter, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Hassanein, Mohamed, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Background
Recent focus to compare resuscitation with balanced fluids and unbalanced solutions has emerged. However, the resuscitative fluid of choice and whether it affects patients’ outcomes remains debatable. We aimed to perform a comprehensive meta-analysis to compare balanced crystalloids and isotonic saline outcomes in critically ill patients.
Methods
A systematic search of Pubmed, Embase and Cochrane was done through May, 2022 of all studies that compared any balanced fluids with isotonic saline and reported at least one of the following outcomes: acute kidney injury (AKI), mortality, and kidney replacement therapy (KRT). Primary outcome was the incidence of AKI. Secondary outcomes included the need for KRT and all-cause mortality. Pooled risk ratio (RR) with the corresponding 95% confidence intervals (CI) were obtained using a random-effect model.
Results
Thirty-one studies were identified and twenty-four studies were included with a total of 48,751 patients. The incidence of AKI was significantly lower in the balanced fluids group compared to the isotonic saline group (14.2% vs 15.2%, p= 0.002) . There was a significant difference in all-cause mortality with lower incidence in the balanced fluids group compared to the isotonic saline group (16.9% vs 19.2%, p= 0.006). There was no significant difference in the incidence of KRT between balanced fluids and normal saline (5.6% vs 6.1%, p= 0.06).
Conclusion
Our study supports the use of balanced crystalloids over isotonic saline for fluid resuscitation in critically ill patients. Compared to normal saline, balanced fluids use resulted in lower mortality rate and incidence of AKI. However, it did not improve the incidence of KRT. Further large-scale clinical studies are needed to validate our findings.