No clear advantage to balanced crystalloids over saline; though 1 study suggests a mortality benefit in patients with sepsis

Référence

Liu C, Lu G, Dong W, et al. Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: a systematic review and meta-analysis with trial sequential analysis. Am J Emerg Med 2019;37(11):2072-2078. Brown RM, Wang L, Coston TD, et al. Balanced crystalloids versus saline in sepsis. A secondary analysis of the SMART clinical trial. Am J Respir Crit Care Med 2019;200(12):1489-1495.

Sommaire

These investigators searched MEDLINE, Cochrane Central, and EMBASE, as well as conference proceedings and reference lists of review articles, to find randomized controlled trials that compared the use of balanced crystalloids with normal saline for fluid resuscitation in critically ill adult patients. The primary outcome was mortality and the secondary outcomes were the incidence of AKI and the need for RRT. Two investigators independently selected studies, extracted data, and assessed the methodological quality of individual studies. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology and was assessed as moderate. Nine studies, including the SMART trial , were included in the meta-analysis. Six of the studies included patients admitted to an intensive care unit, 2 studies included patients with acute pancreatitis, and 1 study included trauma patients. No significant differences were detected between the balanced crystalloids groups and the normal saline groups with regard to mortality, incidence of AKI, or need for RRT. Using trial sequential analysis, the investigators determined that the evidence was not conclusive, and that further large trials are needed to confirm the data. Of note: In a recent secondary analysis of the SMART trial, patients admitted to a medical intensive care unit with sepsis had decreased 30-day in-hospital mortality with the use of balanced crystalloids instead of saline (26.3% vs 31.2%; odds ratio 0.74; 95% CI 0.59 - 0.93; P = .01).