Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
Department of Health Management Institute, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China; Department of National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
Am J Emerg Med. 2019 Nov;37(11):2072-2078. doi: 10.1016/j.ajem.2019.02.045. Epub 2019 Mar 1.
Fluid resuscitation is a fundamental component of the management of critically ill patients, but whether choice of crystalloid affects patient outcomes remains controversial. Therefore, we performed this meta-analysis to compare the efficacy and safety of balanced crystalloids with normal saline.
We searched the MEDLINE, Cochrane Central and EMBASE up to October 2018 to identify randomized controlled trials (RCTs) that compared balanced crystalloids versus normal saline in critically ill patients. The primary outcome was mortality. The secondary results were the incidence of acute kidney injury (AKI) and risk of receiving renal replacement therapy (RRT). Two authors independently screened articles based on the inclusion and exclusion criteria. The meta-analysis was conducted using Revman 5.3, trial sequential analysis (TSA) 0.9 and STATA 12.0.
Nine RCTs were identified. The pooled analyses showed that there were no significant differences in mortality (relative risk (RR) = 0.93, 95% confidence interval (CI) = 0.86, 1.01, P = 0.08), incidence of AKI (RR 0.94, 95% CI 0.88, 1.00, P = 0.06) or RRT use rate (RR 0.94, 95% CI 0.69, 1.27, P = 0.67) between balanced crystalloids and normal saline groups. However, TSA did not provide conclusive evidence.
Among critically ill patients receiving crystalloid fluid therapy, use of a balanced crystalloid compared with normal saline did not reduce the mortality, risk of severe AKI or RRT use rate. Further large randomized clinical trials are needed to confirm or refute this finding.
A protocol of this meta-analysis has been registered on PROSPERO (registration number: CRD42018094857).
液体复苏是危重症患者治疗的基本组成部分，但晶体液选择是否影响患者结局仍存在争议。因此，我们进行了这项荟萃分析，以比较平衡晶体液与生理盐水的疗效和安全性。
我们检索了 MEDLINE、Cochrane 中心和 EMBASE 数据库，截至 2018 年 10 月，以确定比较危重症患者中平衡晶体液与生理盐水的随机对照试验（RCT）。主要结局为死亡率。次要结果为急性肾损伤（AKI）的发生率和接受肾脏替代治疗（RRT）的风险。两位作者独立根据纳入和排除标准筛选文章。使用 Revman 5.3、试验序贯分析（TSA）0.9 和 STATA 12.0 进行荟萃分析。
确定了 9 项 RCT。汇总分析显示，两组死亡率（相对风险（RR）=0.93，95%置信区间（CI）=0.86，1.01，P=0.08）、AKI 发生率（RR 0.94，95%CI 0.88，1.00，P=0.06）或 RRT 使用率（RR 0.94，95%CI 0.69，1.27，P=0.67）无显著差异。然而，TSA 并未提供确凿的证据。
在接受晶体液液体治疗的危重症患者中，与生理盐水相比，使用平衡晶体液并未降低死亡率、严重 AKI 风险或 RRT 使用率。需要进一步的大型随机临床试验来证实或反驳这一发现。
本荟萃分析的方案已在 PROSPERO（注册号：CRD42018094857）上注册。
