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Review
. 2018 Aug 17:6:51.
doi: 10.1186/s40560-018-0320-x. eCollection 2018.

Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis

Yazan Z M Zayed  1   2 , Ahmed M Y Aburahma  1 , Mahmoud O Barbarawi  1 , Kewan Hamid  1 , Momen R N Banifadel  3 , Laith Rashdan  1 , Ghassan I Bachuwa  1
Affiliations
Review

Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis

Yazan Z M Zayed et al. J Intensive Care. .

Abstract

Objectives: Intravenous fluids are one of the most used medical therapy for patients, especially critically ill patients. We conducted a meta-analysis comparing between balanced crystalloids and normal saline in critically ill patients and its effect on various clinical outcomes.

Design: Meta-analysis and systematic review of randomized clinical trials (RCTs).

Methods and data source: Electronic search was performed using PubMed, Cochrane library, and clinical trials.gov from inception through March 1, 2018, with inclusion of prospective studies that investigated one of the primary outcomes which were acute kidney injury (AKI) and in-hospital mortality while secondary outcomes were intensive care unit (ICU) mortality and new renal replacement therapy (RRT).

Results: Six RCTs were included. Total of 19,332 patients were included in the final analysis. There was no significant difference in in-hospital mortality (11.5% vs 12.2%; OR 0.92; 95% CI 0.85-1.01; P = 0.09; I2 = 0%), incidence of AKI (12% vs 12.7%, OR 0.92; 95% CI 0.84-1.01; P = 0.1; I2 = 0), overall ICU mortality (OR 0.9, 95% CI 0.81-1.01, P = 0.08, I2 = 0%), or need for new RRT (OR 0.92, 95% CI 0.67-1.28, P = 0.65, I2 = 38%) between balanced crystalloids and isotonic saline in critically ill patients.

Conclusion: Balanced crystalloids and isotonic saline have no difference on various clinical outcomes including in-hospital mortality, AKI, overall ICU mortality, and new RRT. Further powerful clinical trials are required to determine the relationship between crystalloid fluid type and clinical outcomes.

Keywords: Balanced crystalloids; Critically ill patients; Fluid therapy and meta-analysis; Isotonic saline.

PubMed Disclaimer

Conflict of interest statement

Not applicable.I am the corresponding author (Yazan Zayed) and on behalf of all authors, I consent for the publication of this paper at the Journal of Intensive Care.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search and study selection based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) recommendation
Fig. 2
Fig. 2
Risk of bias summary: review author’s judgments about each risk of bias item for each included study except Ratanarat et al.’s study
Fig. 3
Fig. 3
Forest plot for in-hospital mortality outcome
Fig. 4
Fig. 4
Forest plot for acute kidney injury (AKI)
See this image and copyright information in PMC

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