by A recent review published in The Lancet Respiratory Medicine suggests that the use of balanced crystalloids instead of saline in the intensive care unit (ICU) for adults may significantly reduce in-hospital mortality. The findings of this systematic review and meta-analysis, conducted by Fernando G. Zampieri, Ph.D., and colleagues from HCor Research Institute in São Paulo, Brazil, provide strong evidence that balanced crystalloids offer better outcomes for ICU patients.
The review included data from six randomized controlled trials involving a total of 34,685 participants, with approximately half assigned to receive balanced crystalloids and the other half to receive saline. The analysis revealed that the mortality rate in the hospital was 16.8 percent for those assigned balanced solutions and 17.3 percent for those assigned saline. Although the difference in mortality rates was not statistically significant, the odds ratio of 0.962 suggests a trend towards reduced mortality with the use of balanced crystalloids.
The researchers also observed that the use of balanced crystalloids had a more significant impact on patients with traumatic brain injury. In this subgroup, the mortality rate was 19.1 percent for those assigned balanced solutions and 14.7 percent for those assigned saline. The odds ratio of 1.424 indicates a higher mortality risk with the use of balanced crystalloids in traumatic brain injury patients. However, it is important to note that the overall probability of increased mortality with balanced solutions in traumatic brain injury cases was relatively low.
Despite the potential risks for patients with traumatic brain injury, the review concludes that there is a high probability of reduced in-hospital mortality when using balanced crystalloids compared to saline in the ICU. Additionally, the use of balanced crystalloids also leads to a decreased need for renal replacement therapy. The authors classify the certainty of the evidence supporting these findings as moderate.
It is worth mentioning that multiple authors involved in the research have disclosed ties to the pharmaceutical industry. This disclosure ensures transparency and acknowledges any potential conflicts of interest.
In summary, this review provides valuable insights into the choice of fluids for ICU patients. The use of balanced crystalloids appears to be associated with a reduced risk of in-hospital mortality and a decreased need for renal replacement therapy. However, it is important for healthcare professionals to consider the specific patient population, particularly traumatic brain injury patients, when deciding on the most appropriate fluid management strategy.
