Rawat Neha, Sahni Neeru, Yaddanapudi Lakshminarayana
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Crit Care Med. 2020 Jul;24(7):539-543. doi: 10.5005/jp-journals-10071-23488.
Appropriate early fluid resuscitation is ubiquitous for critically ill patients with metabolic acidosis. Owing to harmful effects of normal saline, commercially prepared balanced salt solutions are being used. However, there is no study comparing use of Ringer's lactate (RL) and commercially available balanced salt solutions in critically ill patients.
A randomized controlled trial was conducted during July 2016 to December 2017. Fifty adult patients admitted to intensive care unit with metabolic acidosis were randomized into group RL or group acetate solution (AC). Respective trial fluid was administered at 20 mL/kg/hour for first hour and 10 mL/kg/hour for second hour. Arterial blood gas analysis samples were taken 15 minutes apart. The fluid resuscitation was continued till pH got corrected to 7.3 or 2 hours, whichever was earlier. The primary aim was to compare time to correct metabolic acidosis in both the groups. The secondary outcomes were the extent of correction of metabolic acidosis, total volume of fluid used, and total cost per patient.
Demographic parameters, APACHE II score, and baseline investigations were comparable. The metabolic acidosis got corrected in 12 patients in group AC and 10 patients in group RL ( value = 0.66). The mean time for correction of metabolic acidosis was 57 ± 3.85 minutes in group RL and 56.25 ± 4.22 minutes in group AC ( value =0.95). The extent of correction of metabolic acidosis and total volume of fluid used was also comparable ( value = 0.05). However, the cost of fluid used was significantly higher in group AC ( value < 0.01).
During administration of balanced salt solutions, RL or AC, in critically ill patients with metabolic acidosis, AC did not confer any advantage in time to or extent of correction of metabolic acidosis.
There is no difference in acid-base status with use of different types of balanced salt solutions for resuscitation in critically ill patients.
Rawat N, Sahni N, Yaddanapudi L. Comparison of Commercially Available Balanced Salt Solution and Ringer's Lactate on Extent of Correction of Metabolic Acidosis in Critically Ill Patients. Indian J Crit Care Med 2020;24(7):539-543.
对于患有代谢性酸中毒的重症患者，早期进行适当的液体复苏是普遍做法。由于生理盐水存在有害影响，目前正在使用商业制备的平衡盐溶液。然而，尚无研究比较乳酸林格液（RL）和市售平衡盐溶液在重症患者中的使用情况。
于2016年7月至2017年12月进行了一项随机对照试验。50例入住重症监护病房且患有代谢性酸中毒的成年患者被随机分为RL组或醋酸盐溶液（AC）组。在第1小时以20 mL/kg/小时的速度给予相应的试验液体，第2小时以10 mL/kg/小时的速度给予。每隔15分钟采集动脉血气分析样本。液体复苏持续进行，直至pH值校正至7.3或持续2小时，以先达到者为准。主要目的是比较两组纠正代谢性酸中毒的时间。次要结局包括代谢性酸中毒的纠正程度、使用的液体总量以及每位患者的总成本。
人口统计学参数、急性生理与慢性健康状况评分系统II（APACHE II）评分以及基线检查结果具有可比性。AC组有12例患者的代谢性酸中毒得到纠正，RL组有10例患者的代谢性酸中毒得到纠正（P值 = 0.66）。RL组纠正代谢性酸中毒的平均时间为57 ± 3.85分钟，AC组为56.25 ± 4.22分钟（P值 = 0.95）。代谢性酸中毒的纠正程度和使用的液体总量也具有可比性（P值 = 0.05）。然而，AC组使用的液体成本显著更高（P值 < 0.01）。
在患有代谢性酸中毒的重症患者中给予平衡盐溶液（RL或AC）时，AC在纠正代谢性酸中毒的时间或程度方面并无任何优势。
在重症患者复苏中使用不同类型的平衡盐溶液，酸碱状态并无差异。
Rawat N, Sahni N, Yaddanapudi L. 市售平衡盐溶液与乳酸林格液对重症患者代谢性酸中毒纠正程度的比较。《印度重症监护医学杂志》2020;24(7):539 - 543。
