Comparative Study

. 2025 Jan;69(1):e14553.

doi: 10.1111/aas.14553.

Preferences and attitudes on acetate- versus lactate-buffered crystalloid solutions for intravenous fluid therapy-An international survey

Karen Louise Ellekjaer^{1

2}, Praleene Sivapalan^{1

2}, Sheila N Myatra³, Lasse Grønningsæter⁴, Johanna Hästbacka⁵, Paul J Young^{6

7

8

9}, Andrew J Boyle^{10

11}, Marlies Ostermann¹², Carmen A Pfortmueller¹³, Ieva Jovaišienė¹⁴, Jan De Waele¹⁵, Annika Reintam Blaser^{16

17}, Abdulrahman Al-Fares¹⁸, Ashish K Khanna^{19

20}, Yaseen M Arabi²¹, Tomoko Fujii^{8

22}, Eric Keus²³, Mervyn Mer^{24

25}, Fayez Alshamsi²⁶, Maria Cronhjort²⁷, Anders Perner^{1

2

28}, Morten H Møller^{1

2

28}; National and site investigators

Collaborators, Affiliations

Collaborators

National and site investigators:
Jan De Waele, Ronni Plovsing, Theis Itenov, Bjørn Anders Brand, Anne Sofie Andreasen, Morten H Bestle, Vera Crone, Lone Musaeus Poulsen, Thomas Hildebrandt, Bodil Steen Rasmussen, Steffen Christensen, Peter Buhl, Karen Louise Ellekjær, Nina Haunstrup Jensen, Anne Craveiro Brøchner, Jens Michelsen, Helle Bundgaard, Hans Fjeldsøe-Nielsen, Kirsten Møller, Emma Atsuko Tsuchiya, Liia Liibusk, Kadri Tamme, Indrek Rätsep, Johanna Hästbacka, Stepani Bendel, Sampsa Suvela, Björn Jäschke, Marika Lähde, Timo Porkkala, Ville Jalkanen, Panu Piirainen, Minna Bäcklund, Sheila Nainan Myatra, Gunjan Chanchalani, Nishanth Baliga, Harsimran Singh Walia, Saswati Sinha, Tomoko Fujii, Shigeki Kushimoto, Yoshiro Hayashi, Akira Endo, Abdulrahman Al-Fares, Ieva Jovaisiene, Ingrida Lisauskiene, Sarunas Judickas, Tomas Tamosuitis, Nerijus Klimas, Paul J Young, Daniel Frei, Jan Mehrtens, Chris Hands, Lasse Grønningsæter, Per Johan Lans, Helge Lappegard Wangberg, Pål Klepstad, Kenneth Lauvås, Ole Kristian Fossum, Thomas Christian Risom Olsen, Kristin Hauss, Trygve Tjugen, Peter Holm, Stephan Balsliemke, Maria Elena Huanca Condori, Aasmund Godø, Tron Blien, Yaseen M Arabi, Mervyn Mer, Maria Cronhjort, Carmen Pfortmueller, Alexa Holliger, Annika Reintam Blaser, Urs Pietsch, Philipp Bühler, Matthias Nebiker, Eric Keus, Maarten van Hasselt, Maarten Vollebergh, Niels Gritters, Bas van Bussel, Fayez Alshamsi, Jihad Mallat, Fayez Alshamsi, Fayez Alshamsi, Fayez Alshamsi, Marlies Ostermann, Andrew Boyle, Andrew Boyle, Paul Johnston, Peter McGuigan, Jon Silversides, Ashish K Khanna

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
² Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
³ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
⁴ Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
⁵ Department of Intensive Care, Tampere University Hospital, Wellbeing Services County of Pirkanmaa and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
⁶ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
⁷ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁸ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁹ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
¹¹ Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
¹² King's College London, Guy's & St Thomas' Hospital London, London, UK.
¹³ Department of Intensive Care, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁴ Vilnius University, Clinic of Anaesthesiology and Intensive care, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
¹⁵ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹⁶ Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
¹⁷ Department of Intensive Care, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹⁸ Department of Anaesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Kuwait City, Kuwait.
¹⁹ Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
²⁰ Outcomes Research Consortium, Cleveland, Ohio, USA.
²¹ Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard- Health Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
²² Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
²³ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²⁴ Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa.
²⁵ Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁶ Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates.
²⁷ Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solnas, Sweden.
²⁸ Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 39627945
DOI: 10.1111/aas.14553

Comparative Study

Preferences and attitudes on acetate- versus lactate-buffered crystalloid solutions for intravenous fluid therapy-An international survey

Karen Louise Ellekjaer et al. Acta Anaesthesiol Scand. 2025 Jan.

. 2025 Jan;69(1):e14553.

doi: 10.1111/aas.14553.

Authors

Collaborators

National and site investigators:
Jan De Waele, Ronni Plovsing, Theis Itenov, Bjørn Anders Brand, Anne Sofie Andreasen, Morten H Bestle, Vera Crone, Lone Musaeus Poulsen, Thomas Hildebrandt, Bodil Steen Rasmussen, Steffen Christensen, Peter Buhl, Karen Louise Ellekjær, Nina Haunstrup Jensen, Anne Craveiro Brøchner, Jens Michelsen, Helle Bundgaard, Hans Fjeldsøe-Nielsen, Kirsten Møller, Emma Atsuko Tsuchiya, Liia Liibusk, Kadri Tamme, Indrek Rätsep, Johanna Hästbacka, Stepani Bendel, Sampsa Suvela, Björn Jäschke, Marika Lähde, Timo Porkkala, Ville Jalkanen, Panu Piirainen, Minna Bäcklund, Sheila Nainan Myatra, Gunjan Chanchalani, Nishanth Baliga, Harsimran Singh Walia, Saswati Sinha, Tomoko Fujii, Shigeki Kushimoto, Yoshiro Hayashi, Akira Endo, Abdulrahman Al-Fares, Ieva Jovaisiene, Ingrida Lisauskiene, Sarunas Judickas, Tomas Tamosuitis, Nerijus Klimas, Paul J Young, Daniel Frei, Jan Mehrtens, Chris Hands, Lasse Grønningsæter, Per Johan Lans, Helge Lappegard Wangberg, Pål Klepstad, Kenneth Lauvås, Ole Kristian Fossum, Thomas Christian Risom Olsen, Kristin Hauss, Trygve Tjugen, Peter Holm, Stephan Balsliemke, Maria Elena Huanca Condori, Aasmund Godø, Tron Blien, Yaseen M Arabi, Mervyn Mer, Maria Cronhjort, Carmen Pfortmueller, Alexa Holliger, Annika Reintam Blaser, Urs Pietsch, Philipp Bühler, Matthias Nebiker, Eric Keus, Maarten van Hasselt, Maarten Vollebergh, Niels Gritters, Bas van Bussel, Fayez Alshamsi, Jihad Mallat, Fayez Alshamsi, Fayez Alshamsi, Fayez Alshamsi, Marlies Ostermann, Andrew Boyle, Andrew Boyle, Paul Johnston, Peter McGuigan, Jon Silversides, Ashish K Khanna

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
² Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
³ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
⁴ Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
⁵ Department of Intensive Care, Tampere University Hospital, Wellbeing Services County of Pirkanmaa and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
⁶ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
⁷ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁸ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁹ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
¹¹ Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
¹² King's College London, Guy's & St Thomas' Hospital London, London, UK.
¹³ Department of Intensive Care, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁴ Vilnius University, Clinic of Anaesthesiology and Intensive care, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
¹⁵ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹⁶ Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
¹⁷ Department of Intensive Care, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹⁸ Department of Anaesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Kuwait City, Kuwait.
¹⁹ Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
²⁰ Outcomes Research Consortium, Cleveland, Ohio, USA.
²¹ Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard- Health Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
²² Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
²³ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²⁴ Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa.
²⁵ Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁶ Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates.
²⁷ Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Solnas, Sweden.
²⁸ Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 39627945
DOI: 10.1111/aas.14553

Abstract

Background: Clinical practice guidelines recommend use of buffered crystalloid solutions in critically ill patients but do not distinguish between solutions based on different buffering anions, that is, acetate- versus lactate-buffered solutions. We therefore surveyed relevant physicians about their preferences and attitudes toward each solution.

Methods: We conducted an international online survey of anesthesiologists (within perioperative care) and intensive care unit (ICU) physicians. The survey comprised 13 questions on respondents' attitudes and preferences regarding the use of acetate- and/or lactate-buffered crystalloid solutions, including their opinions on a potential clinical trial comparing these solutions and the clinical importance of such a trial.

Results: A total of 1321 respondents participated, with a response rate of 34%, ranging from 14% to 96% across 18 countries. Most surveyed physicians reported using buffered crystalloid solutions "very often" (76%) or "often" (16%). Availability of acetate- and lactate-buffered solutions varied, as 35% of respondents reported having both types available, 35% reported having only acetate-, and 24% reported having only lactate-buffered solutions available. Most respondents (87%) would support a randomized trial in adult emergency surgical patients and ICU patients comparing an acetate- versus lactate-buffered crystalloid solution. The median rating of the clinical importance of this question was 5 (interquartile range 4-6) on a scale from 1 to 9.

Conclusions: In this international survey, the reported use of buffered crystalloid solutions was high. Availability of the different solutions varied widely. The support for a potential randomized trial was high, with the clinical importance rated important but not critical by most respondents.

Keywords: acetate; crystalloid; fluid therapy; intravenous fluid; lactate.

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References

REFERENCES

1. Padhi S, Bullock I, Li L, Stroud M, Guideline Development Group. Intravenous fluid therapy for adults in hospital: summary of NICE guidance. BMJ. 2013;347:f7073.
1. Finfer S, Myburgh J, Bellomo R. Intravenous fluid therapy in critically ill adults. Nat Rev Nephrol. 2018;14(9):541‐557.
1. Semler MW, Kellum JA. Balanced crystalloid solutions. Am J Respir Crit Care Med. 2019;199(8):952‐960.
1. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243‐1251.
1. Wear J, McPherson TB, Kolling WM. Stability of sodium bicarbonate solutions in polyolefin bags. Am J Health‐Syst Pharm. 2010;67(12):1026‐1029.

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Preferences and attitudes on acetate- versus lactate-buffered crystalloid solutions for intravenous fluid therapy-An international survey

Collaborators

Affiliations

Preferences and attitudes on acetate- versus lactate-buffered crystalloid solutions for intravenous fluid therapy-An international survey

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources