Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지
DOI QR코드

DOI QR Code

Resuscitation Fluids for Patients at High Risk of Multiple Organ Dysfunction Syndromes: A Systematic Review and Meta-analysis

  • Nam, Jae Hyun (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Kwack, Hee Jin (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Ha, Woo Seob (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University) ;
  • Chung, Jee-Eun (College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University)
  • Received : 2022.08.23
  • Accepted : 2022.09.20
  • Published : 2022.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Intravenous fluid therapy is one of the most common interventions in critically ill patients. Normal saline is frequently used, but there have been some concerns about hyperchloremia. Due to closer to plasma composition, crystalloids have been used as alternatives to normal saline. However, the optimal choice of resuscitative fluids remains controversial. Methods: MEDLINE, EMBASE, and CENTRAL were comprehensively searched until July 2021 to compare balanced crystalloids with normal saline in critically ill patients with the risk factors for multiple organ dysfunction syndromes (MODS).The primary endpoint was composite mortality. Secondary outcomes were acute kidney injury (AKI)/acute renal failure (ARF), and new receipt of renal replacement therapy (RRT). Results: A total of 1,240 studies were searched, and finally, 8 randomized controlled trials and 5 cohort studies were included. In the meta-analysis of composite mortality of 30,710 patients, balanced crystalloids compared to normal saline were significantly associated with reduced mortality (OR 0.80, 95% CI 0.68-0.95). In AKI/ARF, balanced crystalloids had a lower risk than normal saline (OR 0.91, 95% CI 0.84-0.99). There was no difference between balanced crystalloids and normal saline in risk of new receipt of RRT (OR 0.91, 95% CI 0.80-1.04). Conclusion: In fluid resuscitation for patients at high risk of MODS, the use of balanced crystalloids showed a significantly lower incidence of mortality compared to normal saline.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2022R1F1A1075439) and Institute of Information and Communications Technology Planning and Evaluation (IITP) grant funded by the Korea Government (No. 2020-0-01343, Artificial Intelligence Convergence Research Center, Hanyang University ERICA).

References

  1. National Institude for Health and Care Excellence. Clinical guideline: Intravenous fluid therapy in adults in hospital. Available from: https://www.nice.org.uk/guidance/cg174/chapter/1-Recommendations. Accessed December 7, 2021
  2. Li H, Sun SR, Yap JQ, Chen JH, Qian Q. 0.9% saline is neither normal nor physiological. J Zhejiang Univ Sci B 2016;17(3):181-7. https://doi.org/10.1631/jzus.B1500201
  3. Pfortmueller CA, Fleischmann E. Acetate-buffered crystalloid fluids: current knowledge, a systematic review. J Crit Care 2016;35:96-104. https://doi.org/10.1016/j.jcrc.2016.05.006
  4. Potura E, Lindner G, Biesenbach P, et al. An acetate-buffered balanced crystalloid versus 0.9% saline in patients with end-stage renal disease undergoing cadaveric renal transplantation: a prospective randomized controlled trial. Anesth Analg 2015;120(1):123-9. https://doi.org/10.1213/ANE.0000000000000419
  5. Orbegozo D, Su F, Santacruz C, et al. Effects of different crystalloid solutions on hemodynamics, peripheral perfusion, and the microcirculation in experimental abdominal sepsis. Anesthesiology 2016;125(4):744-54. https://doi.org/10.1097/ALN.0000000000001273
  6. Kellum JA, Song M, Venkataraman R. Effects of hyperchloremic acidosis on arterial pressure and circulating inflammatory molecules in experimental sepsis. Chest 2004;125(1):243-8. https://doi.org/10.1378/chest.125.1.243
  7. Neyra JA, Canepa-Escaro F, Li X, et al. Association of hyperchloremia with hospital mortality in critically ill septic patients. Crit Care Med 2015;43(9):1938-44. https://doi.org/10.1097/CCM.0000000000001161
  8. Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012;308(15):1566-72. https://doi.org/10.1001/jama.2012.13356
  9. McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg 2013;117(2):412-21. https://doi.org/10.1213/ANE.0b013e318293d81e
  10. Kimura S, Matsumoto S, Muto N, et al. Association of serum chloride concentration with outcomes in postoperative critically ill patients: a retrospective observational study. J Intensive Care 2014;23(2):39-45.
  11. Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest 1983;71(3):726-35. https://doi.org/10.1172/JCI110820
  12. Jackson CD, Patel SB, Haltom MB, et al. Choice of intravenous crystalloid fluid and mortality in critically ill adult patients. South Med J 2019;112(7): 401-5. https://doi.org/10.14423/SMJ.0000000000000993
  13. Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018;378(9):829-39. https://doi.org/10.1056/NEJMoa1711584
  14. de-Madaria E, Herrera-Marante I, Gonzalez-Camacho V, et al. Fluid resuscitation with lactated Ringer's solution vs normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial. United European Gastroenterol J 2018;6(1):63-72. https://doi.org/10.1177/2050640617707864
  15. Duffy RA, Foroozesh MB, Loflin RD, et al. Normal saline versus Normosol™-R in sepsis resuscitation: A retrospective cohort study. J Intensive Care Soc 2019;20(3):223-30. https://doi.org/10.1177/1751143718786113
  16. Lipinski M, Rydzewska-Rosolowska A, Rydzewski A, Rydzewska G. Fluid resuscitation in acute pancreatitis: Normal saline or lactated Ringer's solution? World J Gastroenterol 2015;21(31):9367-72. https://doi.org/10.3748/wjg.v21.i31.9367
  17. Brown DL. Cardiac Intensive Care-E-Book; 3rd, Ed. Elsevier Health Sciences, 2018: 208-15.
  18. Guerci P, Ince C. Endothelial dysfunction of the kidney in sepsis. In: Ronco C, Bellomo R, Kellum JA, Ricii Z, eds. Critical Care Nephrology, 3rd ed. United States: Elsevier, 2019: 518-524.
  19. Bennett JE, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease 9th ed. Springer, 2019: 990-1008.
  20. Porro L.J, Demling RH, Pereira, CT., et al. Care of geriatric patients. 4th Ed. In Total Burn Care. Elsevier Inc. 2012: 415-19.
  21. Schoenberg MH, Weiss M, Radermacher P. Outcome of patients with sepsis and septic shock after ICU treatment. Langenbecks Arch Surg 1998;383(1):44-8. https://doi.org/10.1007/s004230050090
  22. Chung KK, Blackbourne LH, Wolf S, et al. Evolution of burn resuscitation in operation Iraqi freedom. J Burn Care Research 2006;27(5):606-11. https://doi.org/10.1097/01.BCR.0000235466.57137.f2
  23. Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med 1999;131(1):47-59. https://doi.org/10.7326/0003-4819-131-1-199907060-00010
  24. Wiggers CJ. Physiology of shock. 1st Ed. Commonwealth Fund, 1950;423-40.
  25. Brown AF. Anaphylactic shock: mechanisms and treatment. J Accid Emerg Med 1995;12(2):89-100. https://doi.org/10.1136/emj.12.2.89
  26. Mizock BA. The multiple organ dysfunction syndrome. Dis Mon 2009;55(8):476-526. https://doi.org/10.1016/j.disamonth.2009.04.002
  27. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clinic North Am 2012;92(6):1403-23. https://doi.org/10.1016/j.suc.2012.08.006
  28. Halonen KI, Pettila V, Leppaniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK. Multiple organ dysfunction associated with severe acute pancreatitis. Crit Care Med 2002;30(6):1274-9. https://doi.org/10.1097/00003246-200206000-00019
  29. Raghunathan K, Shaw A, Nathanson B, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med 2014;42(7):1585-91. https://doi.org/10.1097/CCM.0000000000000305
  30. Page MJ, McKenzoe JE, Bossuyt PM, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol 2021;134:103-12. https://doi.org/10.1016/j.jclinepi.2021.02.003
  31. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818-29. https://doi.org/10.1097/00003246-198510000-00009
  32. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270(24):2957-63. https://doi.org/10.1001/jama.1993.03510240069035
  33. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286(14):1754-8. https://doi.org/10.1001/jama.286.14.1754
  34. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8(4):R204-12. https://doi.org/10.1186/cc2872
  35. Lopes JA., Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J 2013;6(1): 8-14. https://doi.org/10.1093/ckj/sfs160
  36. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Prac 2012;120(4):c179-84. https://doi.org/10.1159/000339789
  37. Turner RM, Bird SM, Higgins JP. The impact of study size on metaanalyses: examination of underpowered studies in Cochrane reviews. PLoS One 2013;8(3):e59202. https://doi.org/10.1371/journal.pone.0059202
  38. Furlan AD, Malmivaara A, Chou R, Maher CG, et al. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976) 2015;40(21):1660-73. https://doi.org/10.1097/BRS.0000000000001061
  39. Semler MW, Wanderer JP, Ehrenfeld JM, et al. Balanced crystalloids versus saline in the intensive care unit. The SALT randomized trial. Am J Respir Crit Care Med 2017;195(10):1362-72. https://doi.org/10.1164/rccm.201607-1345OC
  40. Kumar S, Golla R, Bhalla A, Sharma N, Varma S. 0.9% Saline v/s Ringer's Lactate for fl uid resuscitation in adult sepsis patients in emergency medical services: An open label Randomized Controlled trial. J Assoc Physicians India 2020;68(1):87.
  41. Verma B, Luethi N, Cioccari L, et al. A multicentre, randomised controlled pilot study of fluid resuscitation with saline or PlasmaLyte 148 in critically ill patients. Crit Care Resusc 2016;18(3):205-12.
  42. Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 2011;9(8):710-7.e1. https://doi.org/10.1016/j.cgh.2011.04.026
  43. Aboelsoud MM, Siddique O, Morales A, Seol Y, Al-Qadi MO. Fluid choice matters in critically-ill patients with acute pancreatitis: Lactated ringer's vs. isotonic saline. R I Med J (2013) 2016;99(10):39-42.
  44. Young P, Bailey M, Beasley R, et al. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial. JAMA 2015;314(16):1701-10. https://doi.org/10.1001/jama.2015.12334
  45. Shaw AD, Schermer CR, Lobo DN, et al. Impact of intravenous fluid composition on outcomes in patients with systemic inflammatory response syndrome. Crit Care 2015;19(1):334-43. https://doi.org/10.1186/s13054-015-1045-z
  46. Jackson KE, Wang L, Casey JD, et al. Effect of early balanced crystalloids before ICU admission on sepsis outcomes. Chest 2021;159(2):585-95. https://doi.org/10.1016/j.chest.2020.08.2068
  47. Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: The BaSICS randomized clinical trial. JAMA 2021;326(9):818-29. https://doi.org/10.1001/jama.2021.11684
  48. Liu C, Lu G, Wang D, 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):2072-8. https://doi.org/10.1016/j.ajem.2019.02.045
  49. Li B, Zhao H, Zhang J, Yan Q, Li T, Liu L. Resuscitation fluids in septic shock: A network meta-analysis of randomized controlled trials. Shock 2020;53(6):679-85. https://doi.org/10.1097/SHK.0000000000001468
  50. Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu YK. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses. Crit Care 2020;24(1):693-705. https://doi.org/10.1186/s13054-020-03419-y
  51. Tseng CH, Chen TT, Chan MC, et al. Impact of comorbidities on beneficial effect of lactated ringers versus saline in sepsis patients. Front Med 2021;8:758902. https://doi.org/10.3389/fmed.2021.758902
  52. Wakabayashi Y, Sakamoto H, Mishina T, Marumo F. Hyperchloremia in patients with chronic renal failure. Tohoku J Exp Med 1986;149(2):145-50. https://doi.org/10.1620/tjem.149.145