Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis.
Ann Pharmacother
; 54(1): 5-13, 2020 01.
Article
em En
| MEDLINE
| ID: mdl-31364382
ABSTRACT
Background:
The optimal resuscitative fluid remains controversial.Objective:
To assess the association between crystalloid fluid and outcomes in critically ill adults.Methods:
Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, and Cochrane Central Register for Controlled Trials were searched from inception through July 2019. Cohort studies and randomized trials of critically ill adults provided predominantly nonperioperative fluid resuscitation with balanced crystalloids or 0.9% sodium chloride (saline) were included.Results:
Thirteen studies (n = 30 950) were included. Balanced crystalloids demonstrated lower hospital or 28-/30-day mortality (risk ratio [RR] = 0.86; 95% CI = 0.75-0.99; I2 = 82%) overall, in observational studies (RR = 0.64; 95% CI = 0.41-0.99; I2 = 63%), and approached significance in randomized trials (RR = 0.94; 95% CI = 0.88-1.02; I2 = 0%). New acute kidney injury occurred less frequently with balanced crystalloids (RR = 0.91; 95% CI = 0.85-0.98; I2 = 0%), though progression to renal replacement therapy was similar (RR = 0.91; 95% CI = 0.79-1.04; I2 = 38%). In the sepsis cohort, odds of hospital or 28-/30-day mortality were similar, but the odds of major adverse kidney events occurring in the first 30 days were less with balanced crystalloids than saline (OR = 0.78; 95% CI = 0.66-0.91; I2 = 42%). Conclusion and Relevance Resuscitation with balanced crystalloids demonstrated lower hospital or 28-/30-day mortality compared with saline in critically ill adults but not specifically those with sepsis. Balanced crystalloids should be provided preferentially to saline in most critically ill adult patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cloreto de Sódio
/
Soluções para Reidratação
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Sepse
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Hidratação
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Soluções Cristaloides
Tipo de estudo:
Clinical_trials
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Observational_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Adult
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Humans
Idioma:
En
Revista:
Ann Pharmacother
Assunto da revista:
FARMACOLOGIA
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TERAPIA POR MEDICAMENTOS
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Estados Unidos