Balanced Crystalloids versus Normal Saline as Intravenous Fluid Therapy among Critically Ill patients: A meta-analysis of randomized controlled trials

ABSTRACT

Introduction@#Recent studies on critically ill adults has shown that use of normal saline with its supraphysiologic chloride content has been associated with an increased incidence of hyperchloremic metabolic acidosis, acute kidney injury (AKI), renal replacement therapy (RRT), hypotension and death. The objective of this meta-analysis was to assess the clinical outcomes associated with the use of balanced crystalloids versus normal saline solution.@*Methods@#We searched PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Our inclusion criteria were the following randomized controlled trials, adult critically ill patients, comparisons between patients receiving either balanced crystalloids (lactated ringer’s solution, plasma-lyte) or normal saline, and at least one endpoint that measure intensive care unit mortality, risk of AKI (defined as stage 2 or greater in the RIFLE criteria) and risk of RRT. Risk ratios (RRs) and confidence intervals (C.I) were calculated via Review Manager Version 5.3 using the fixed-effect modelling.@*Results@#A total of four randomized controlled trials, which were all assessed to be good quality and low risk of bias, with 19,105 patients were included. Use of balanced crystalloids showed a trend towards lower incidence of AKI (RR 0.94, 95% C.I [0.87-1.02], P=0.69), RRT use (RR 0.91, 95% C.I. [0.771.07], P=0.29) and ICU mortality (RR 0.91, 95% C.I. [0.82-1.01], P=0.95). There is no significant heterogeneity identified.@*Conclusion@#Use of balanced crystalloids as intravenous fluid therapy among critically ill patients demonstrated a trend toward lower incidence of AKI, RRT and ICU mortality, compared to normal saline solution.