Balanced crystalloids vs 0.9% saline for adult patients undergoing non-renal surgery: A meta-analysis

Lili Huang, Xiaoshuang Zhou, Hai Yu
International Journal of Surgery 2018, 51: 1-9

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.

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