Evidence map›Paper›PMID 34559108›Full record

SynthesisMedicine2021

Balanced crystalloids versus saline in critically ill patients: The PRISMA study of a meta-analysis.

Yuhan Zhu, Nan Guo, Maifen Song, Fei Xia, Yanqing Wu, Xusheng Wang, Tengfei Chen, Zhihai Yang, Siwen Yang, Yu Zhang and 3 more

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Guideline
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Yuhan ZhuICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.ORCID 0000-0002-7840-9696
Nan GuoDongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China.
Maifen SongICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Fei XiaICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Yanqing WuICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Xusheng WangICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Tengfei ChenICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Zhihai YangICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Siwen YangICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Yu ZhangICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Xin ZhangICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Qingquan ShiICU Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Xiaoxu ShenDongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare the safety of balanced crystalloids and saline among critically ill patients in intensive care unit (ICU).

methodsThe Medline, EMBASE, Web of Science, Cochrane Library databases were systematically searched from the inception dates to May 17, 2020 in order to identify randomized controlled trials which evaluated the safety of balanced crystalloids and saline in critically ill patients. The primary outcome was major adverse kidney events within 30 days (MAKE30). The second outcomes included 30-day mortality, ICU mortality, In-hospital mortality, ICU length of stay, hospital length of stay, creatinine highest before discharge (mg/dl) and needs for renal replacement therapy (RRT).

resultsA total of nine randomized controlled trials involving 19,578 critical ill patients fulfilled the inclusion criteria. The outcomes of this meta-analysis showed that balanced crystalloids treatment shared the same risk of MAKE30 with saline treatment among critical ill patients [RR = 0.95; 95%CI, 0.88 to 1.01; Z = 1.64 (P = .102)]. The clinical mortality which included 30-day mortality [RR = 0.92; 95%CI, 0.85 to 1.01; Z = 1.78 (P = .075)], ICU mortality [RR = 0.92; 95%CI, 0.83 to 1.02; Z = 1.67 (P = .094)] and In-hospital mortality [RR = 0.93; 95%CI, 0.71 to 1.21; Z = 0.55 (P = .585)] were similar between balanced crystalloids treatment and saline treatment among critical ill patients. Patients who received balanced crystalloids treatment or saline treatment needed the same length of ICU stay [WMD = 0.00; 95%CI, -0.09 to 0.10; Z = 0.09 (P = .932)] and hospital stay [WMD = 0.59; 95%CI, -0.33 to 1.51; Z = 1.26 (P = .209)]. Critical ill patients who received balanced crystalloids treatment or saline treatment had the same level of creatinine highest before discharge [WMD = 0.01; 95%CI, -0.02 to 0.04; Z = 0.76 (P = .446)] and needs for RRT [RR = 1.04; 95%CI, 0.75 to 1.43; Z = 0.21 (P = .830)]. Similar results were obtained in subgroups of trials stratified according to the age of patients (children or adults).

conclusionsWhen compared with saline, balanced crystalloids could not reduce the risk of MAKE30, 30-day mortality, ICU mortality and in-hospital mortality, could not reduce the length of ICU stay, length of hospital stay, the level of creatinine highest before discharge and the needs for RRT among critical ill children and adults. Therefore, it was still too early for balanced crystalloids to replace normal saline among critical ill patients.

Indexed as

Critical IllnessCrystalloid SolutionsFluid TherapyHumansIntensive Care UnitsRandomized Controlled Trials as TopicSaline SolutionCrystalloid SolutionsSaline Solution

Identifiers

PMID34559108
PMCPMC8462635

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.