Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children.
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ABSTRACT:
SUBMITTER: Florez ID
PROVIDER: S-EPMC10192509 | biostudies-literature | 2023 May
REPOSITORIES: biostudies-literature
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Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children.
Florez Ivan D ID Sierra Javier J Pérez-Gaxiola Giordano G
The Cochrane database of systematic reviews 20230517
<h4>Background</h4>Although acute diarrhoea is a self-limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's ...[more]
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Project description:Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of balanced crystalloid solutions in comparison to 0.9% saline to rehydrate children with severe dehydration due to acute diarrhoea.
| S-EPMC7266490 | biostudies-literature
Project description:Intravenous fluid therapy is the most common intervention received by acutely ill patients. Historically, saline (0.9% sodium chloride) has been the most frequently administered intravenous fluid, especially in North America. Balanced crystalloid solutions (e.g., lactated Ringer's, Plasma-Lyte) are an increasingly used alternative to saline. Balanced crystalloids have a sodium, potassium, and chloride content closer to that of extracellular fluid and, when given intravenously, have fewer adverse effects on acid-base balance. Preclinical research has demonstrated that saline may cause hyperchloremic metabolic acidosis, inflammation, hypotension, acute kidney injury, and death. Studies of patients and healthy human volunteers suggest that even relatively small volumes of saline may exert physiological effects. Randomized trials in the operating room have demonstrated that using balanced crystalloids rather than saline prevents the development of hyperchloremic metabolic acidosis and may reduce the need for vasopressors. Observational studies among critically ill adults have associated receipt of balanced crystalloids with lower rates of complications, including acute kidney injury and death. Most recently, large randomized trials among critically ill adults have examined whether balanced crystalloids result in less death or severe renal dysfunction than saline. Although some of these trials are still ongoing, a growing body of evidence raises fundamental concerns regarding saline as the primary intravenous crystalloid for critically ill adults and highlights fundamental unanswered questions for future research about fluid therapy in critical illness.
| S-EPMC6467313 | biostudies-literature
Project description:BackgroundIntravenous fluid therapy is important for pediatric and adult patients in intensive care units (ICUs). However, medical professionals continue to struggle to determine the most appropriate fluids to obtain the best possible outcomes for each patient.ObjectiveWe conducted a meta-analysis involving cohort studies and randomized controlled trials (RCTs) to compare the influence of balanced crystalloid solutions and normal saline among patients in ICUs.Patients and methodsStudies that compared balanced crystalloid solutions and saline in ICU patients from databases including PubMed, Embase, Web of Science, and Cochrane Library were systematically searched up to July 25, 2022. The primary outcomes were mortality and renal-related outcomes, which included major adverse kidney events within 30 days (MAKE30), acute kidney injury (AKI), new receipt of renal replacement therapy (RRT), maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline. Service utilization including length of hospital stay, ICU stay, ICU-free days and ventilator-free days were also reported.ResultsA total of 13 studies (10 RCTs and 3 cohort studies) involving 38,798 patients in ICUs met the selection criteria. Our analysis revealed that each subgroup had no significant difference in mortality outcomes among ICU patients between balanced crystalloid solutions and normal saline. A significant difference was detected between the adult groups (odds ratio [OR], 0.92; 95% confidence interval [CI], [0.86, 1.00]; p = 0.04) indicating that the AKI in the balanced crystalloid solutions group was lower than that in the normal saline group. Other renal-related outcomes, such as MAKE30, RRT, maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline showed no significant difference between the two groups. Regarding secondary outcomes, the balanced crystalloid solution group had a longer ICU stay time (WMD, 0.02; 95% CI, [0.01, 0.03]; p = 0.0004 and I2 = 0%; p = 0.96) than the normal saline group among adult patients. Furthermore, children treated with balanced crystalloid solution had a shorter hospital stay time (WMD, - 1.10; 95% CI, [- 2.10, - 0.10]; p = 0.03 and I2 = 17%; p = 0.30) than those treated with saline.ConclusionsCompared with saline, balanced crystalloid solutions could not reduce the risk of mortality and renal-related outcomes, including MAKE30, RRT, maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline, but the solutions may reduce total AKI incidence among adult patients in ICUs. For service utilization outcomes, balanced crystalloid solutions were associated with a longer length of ICU stay in the adult group and shorter length of hospital stay in the pediatric group.
| S-EPMC10560196 | biostudies-literature
Project description:BackgroundPerioperative intravenous fluids are administered to kidney transplant recipients to maintain hemodynamic stability and graft perfusion; however, the ideal fluid remains uncertain. Although 0.9% saline (saline) is commonly used, its high chloride content causes hyperchloremic metabolic acidosis and may increase the risks of delayed graft function (DGF) and hyperkalemia. Balanced electrolyte solutions (BES) have a more physiological chloride concentration and may reduce these risks. Previous meta-analyses found insufficient evidence to compare BES with saline for these outcomes; however, new studies have recently been published. In this updated review, we compared the effects of BES with saline on the risk of DGF and hyperkalemia in kidney transplantation.MethodsMEDLINE, Embase, and CENTRAL were searched for randomized controlled trials comparing BES with saline in kidney transplantation. The primary outcomes were DGF and hyperkalemia. Eligible studies were assessed for risk of bias and data were pooled for analysis. The Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the quality of evidence.ResultsTen studies involving 1532 participants were included. The quality of evidence was high for deceased donor transplantation and very low for living donor transplantation. The relative risk (RR) of DGF associated with BES compared with saline was 0.83 (95% confidence interval [CI], 0.71-0.96; P = 0.01) in deceased donor transplantation. There was no difference in DGF in living donor transplantation (RR 0.79; 95% CI, 0.26-2.41; P = 0.68). There was no difference in hyperkalemia between groups (RR 0.87; 95% CI, 0.59-1.27; P = 0.46).ConclusionsCompared with saline, BES reduces the risk of DGF in deceased donor kidney transplantation without increasing hyperkalemia.
| S-EPMC11649268 | biostudies-literature
Project description: Not available
| S-EPMC6680295 | biostudies-literature
Project description: Not available
| S-EPMC6647932 | biostudies-literature
Project description:Balanced crystalloids may improve outcomes compared with saline for some critically ill adults. Lower tonicity of balanced crystalloids could worsen cerebral edema in patients with intracranial pathology. The effect of balanced crystalloids versus saline on clinical outcomes in patients with traumatic brain injury (TBI) requires further study. We planned an a priori subgroup analysis of TBI patients enrolled in the pragmatic, cluster-randomized, multiple-crossover Isotonic Solutions and Major Adverse Renal Events Trial (SMART) (ClinicalTrials.gov: NCT02444988, NCT02547779). Primary outcome was 30-day in-hospital mortality. Secondary outcomes included hospital discharge disposition (home, facility, death). Regression models adjusted for pre-specified baseline covariates compared outcomes. TBI patients assigned to balanced crystalloids (n = 588) and saline (n = 569) had similar baseline characteristics including Injury Severity Score 19 (10); mean maximum head/neck Abbreviated Injury Score, 3.4 (1.0). Isotonic crystalloid volume administered between intensive care unit admission and first of hospital discharge or 30 days was 2037 (3470) mL and 1723 (2923) mL in the balanced crystalloids and saline groups, respectively (p = 0.18). During the study period, 94 (16%) and 82 (14%) patients (16%) died in the balanced crystalloid and saline groups, respectively (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.60 to 1.75; p = 0.913). Patients in the balanced crystalloid group were more likely to die or be discharged to another medical facility (aOR 1.38 [1.02-1.86]; p = 0.04). Overall, balanced crystalloids were associated with worse discharge disposition in critically injured patients with TBI compared with saline. The confidence intervals cannot exclude a clinically relevant increase in mortality when balanced crystalloids are used for patients with TBI.
| S-EPMC9422787 | biostudies-literature
Project description:BackgroundFluid resuscitation is a cornerstone of septic shock management in pediatric patients, with normal saline (NS) being the traditional choice. However, balanced solutions (BS) have gained attention due to their potential to mitigate acid-base and electrolyte disturbances. Despite this, the optimal choice between BS and NS for pediatric sepsis remains unclear. Therefore, we aimed to conduct a meta-analysis comparing the clinical outcomes of BS versus NS in pediatric patients with sepsis.MethodsWe systematically searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, along with reference lists of retrieved publications, for studies comparing clinical outcomes in pediatric patients with sepsis treated with BS versus NS. Our outcomes of interest included acute kidney injury (AKI), hospital mortality, hospital length of stay, pediatric intensive care unit (PICU) length of stay, need for renal replacement therapy, hyperchloremia and mechanical ventilation. We performed statistical analysis using Review Manager Web 8.0.0 and Rstudio.ResultsWe included 12,231 patients from 8 studies, of which 4 were randomized clinical trials (RCTs). BS was used to treat septic shock in 2,460 (20.1%) patients. The mean age was 5.98 ± 3.08 years, with 43.82% female patients. Follow-up ranged from 3 to 90 days. We found no statistically significant difference between groups in AKI, hospital mortality, mechanical ventilation, need for renal replacement therapy, and PICU length of stay. Hospital length of stay in days was significantly longer with BS compared to NS (MD 3.38; 95% CI 1.13 to 5.64; p = 0.003; I² = 0%) and the occurrence of hyperchloremia was lower in the BS compared to NS (RR 0.70; 95% CI 0.59 to 0.82; p = 0.0001; I² = 0%). In a subgroup analysis of RCTs only, AKI occurrence was not significantly different between BS and NS groups (RR 0.81; 95% CI 0.48 to 1.38; p = 0.44; I² = 18%). However, the need for renal replacement therapy was significantly less frequent in patients treated with BS compared to NS (RR 0.58; 95% CI 0.39 to 0.87; p = 0.008; I² = 0%).ConclusionIn pediatric septic shock patients, treatment with balanced solutions (BS) was associated with a lower need for renal replacement therapy and a reduced occurrence of hyperchloremia. However, hospital length of stay was longer in patients treated with BS compared to those receiving normal saline (NS). These results underscore the complexity of fluid management in pediatric septic shock and emphasize the need for further research.
| S-EPMC11783956 | biostudies-literature
Project description: Not available
| S-EPMC6680297 | biostudies-literature
Project description:BackgroundInfusion therapy is one of the most frequently prescribed medications in hospitalized patients. Currently used crystalloid solutes have a variable composition and may therefore influence acid-base status, intracellular and extracellular water content and plasma electrolyte compositions and have a major impact on organ function and outcome. The aim of our study was to investigate whether use of acetate-based balanced crystalloids leads to better hemodynamic stability compared to 0.9% saline.MethodsWe performed a sub-analysis of a prospective, randomized, controlled trial comparing effects of 0.9% saline or an acetate-buffered, balanced crystalloid during the perioperative period in patients with end-stage renal disease undergoing cadaveric renal transplantation. Need for catecholamine therapy and blood pressure were the primary measures.ResultsA total of 150 patients were included in the study of which 76 were randomized to 0.9% saline while 74 received an acetate-buffered balanced crystalloid. Noradrenaline for cardiocirculatory support during surgery was significantly more often administered in the normal saline group, given earlier and with a higher cumulative dose compared to patients receiving an acetate-buffered balanced crystalloid (30% versus 15%, p = 0.027; 68 ± 45 µg/kg versus 75 ± 60 µg/kg, p = 0.0055 and 0.000492 µg/kg body weight/min, ±0.002311 versus 0.000107 µg/kg/min, ±0.00039, p = 0.04, respectively). Mean minimum arterial blood pressure was significantly lower in patients randomized to 0.9% saline than in patients receiving the balanced infusion solution (57.2 [SD 8.7] versus 60.3 [SD 10.2] mm Hg, p = 0.024).ConclusionThe use of an acetate-buffered, balanced infusion solution results in reduced need for use of catecholamines and cumulative catecholamine dose for hemodynamic support and in less occurrence of arterial hypotension in the perioperative period. Further research in the field is strongly encouraged.
| S-EPMC5599439 | biostudies-literature