Balanced Crystalloids versus Saline in Critically Ill Adults - A Systematic Review with Meta-Analysis
Hammond NE, Zampieri FG, Di Tanna GL, et al., 2022 · 13 studies included
Summary
Systematic review of 13 randomized trials (35,884 participants); the low-risk-of-bias trials yielded an RR for 90-day mortality of 0.96 (95% CI 0.91-1.01), with no clear reduction in acute kidney injury or renal replacement therapy.
Conclusion
Balanced crystalloids may have a small average benefit over saline, but conventional confidence intervals include no mortality effect. This supports a preference rather than a claim of a large or certain mortality benefit.
Clinical Context & Relevant Topics (4)
Disease ReferenceLife-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.
The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.
Sepsis-AKI microcirculatory decoupling, KDIGO staging, Furosemide Stress Test (FST), urine microscopy, and the AEIOU dialysis threshold framework.
Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.