1.
Ringer's lactate versus normal saline in acute pancreatitis: A systematic review and meta-analysis.
Iqbal, U, Anwar, H, Scribani, M
Journal of digestive diseases. 2018;(6):335-341
Abstract
OBJECTIVE Aggressive i.v. hydration with crystalloids is the first step in managing acute pancreatitis (AP) and is associated with improved survival. Guidelines about the choice of crystalloids to use are unclear. This systematic review and meta-analysis was aimed to discern whether the choice of fluids in managing pancreatitis was associated with patients' outcomes. METHODS A comprehensive literature review was conducted by searching the Embase, MEDLINE, PubMed and Google Scholar databases to December 2017 to identify all studies that compared normal saline (NS) with Ringer's lactate (RL) for managing AP. The characteristics of the participants, outcome measurements (including mortality, the development of systemic inflammatory response syndrome [SIRS] on admission and at 24 h, and pancreatic necrosis) were analyzed. RESULTS Five studies (three randomized controlled trials and two retrospective cohort studies) with 428 patients were included in this analysis. Mortality trended lower in the RL group but this was not statistically significant (pooled odds ratio [OR] 0.61, 95% CI 0.28-1.29, P = 0.20). Patients in the RL group had significantly decreased odds of developing SIRS at 24 h (pooled OR 0.38, 95% CI 0.15-0.98, P = 0.05). CONCLUSIONS RL has anti-inflammatory effects and is associated with decreased odds of persistent SIRS at 24 h, which is a marker of severe disease in AP patients. Although mortality trended lower in the RL group this did not achieve statistical significance and hence larger randomized controlled trials are needed to evaluate this association.
2.
Balanced crystalloids vs 0.9% saline for adult patients undergoing non-renal surgery: A meta-analysis.
Huang, L, Zhou, X, Yu, H
International journal of surgery (London, England). 2018;:1-9
-
-
Free full text
-
Abstract
BACKGROUND Fluid maintenance and resuscitation is an important strategy during major surgeries. There has been a debate on the choice of crystalloids over the past decades. 0.9% saline (normal saline) is more likely to cause hyperchloremic acidosis when compared to balanced crystalloids with low chloride content. Meta-analyses comparing these two kinds of crystalloids have been performed in renal transplantations. We aim to compare the safety of balanced crystalloids to normal saline among adult patients undergoing non-renal surgery. METHODS Relevant articles were searched through PubMed, Embase and the Cochrane Library. Nine randomized controlled trials (including 871 participants) comparing balanced crystalloids to normal saline on adult patients undergoing non-renal surgery were finally included. Possible effects were calculated using meta-analysis. RESULTS Patients in the normal saline group had significantly lower postoperative pH (MD: 0.05; 95% CI: 0.04-0.06; p < .001; I2 = 82%) and base excess (MD: 2.04; 95% CI: 1.44-2.65; p < .001; I2 = 87%). The postoperative serum chloride level was significantly higher in the normal saline group (MD: -4.79; 95% CI: -8.13∼-1.45; p = .005; I2 = 95%). CONCLUSION Comparing to normal saline, balanced crystalloids are more beneficial in keeping postoperative electrolytes and acid-base balance among adult patients undergoing non-renal surgery. Future researches should pay more attention to meaningful clinical outcomes concerning the safety of balanced crystalloids and normal saline.