Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation
Background The objective of this systematic review and meta‐analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting. Methods Systematic searches were performed of PubMed/MEDLINE, Emba...
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| Published in: | British journal of surgery Vol. 102; no. 1; pp. 24 - 36 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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Chichester, UK
John Wiley & Sons, Ltd
01.01.2015
Oxford University Press |
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| ISSN: | 0007-1323, 1365-2168, 1365-2168 |
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| Abstract | Background
The objective of this systematic review and meta‐analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.
Methods
Systematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high‐chloride (ion concentration greater than 111 mmol/l up to and including 154 mmol/l) or lower‐chloride (concentration 111 mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed‐effect modelling.
Results
The search identified 21 studies involving 6253 patients. High‐chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1·64, 95 per cent c.i. 1·27 to 2·13; P < 0·001) and hyperchloraemia/metabolic acidosis (RR 2·87, 1·95 to 4·21; P < 0·001). High‐chloride fluids were also associated with greater serum chloride (MD 3·70 (95 per cent c.i. 3·36 to 4·04) mmol/l; P < 0·001), blood transfusion volume (SMD 0·35, 0·07 to 0·63; P = 0·014) and mechanical ventilation time (SMD 0·15, 0·08 to 0·23; P < 0·001). Sensitivity analyses excluding heavily weighted studies resulted in non‐statistically significant effects for acute kidney injury and mechanical ventilation time.
Conclusion
A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content.
Chloride associated with morbidity but not mortality |
|---|---|
| AbstractList | Background
The objective of this systematic review and meta‐analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.
Methods
Systematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high‐chloride (ion concentration greater than 111 mmol/l up to and including 154 mmol/l) or lower‐chloride (concentration 111 mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed‐effect modelling.
Results
The search identified 21 studies involving 6253 patients. High‐chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1·64, 95 per cent c.i. 1·27 to 2·13; P < 0·001) and hyperchloraemia/metabolic acidosis (RR 2·87, 1·95 to 4·21; P < 0·001). High‐chloride fluids were also associated with greater serum chloride (MD 3·70 (95 per cent c.i. 3·36 to 4·04) mmol/l; P < 0·001), blood transfusion volume (SMD 0·35, 0·07 to 0·63; P = 0·014) and mechanical ventilation time (SMD 0·15, 0·08 to 0·23; P < 0·001). Sensitivity analyses excluding heavily weighted studies resulted in non‐statistically significant effects for acute kidney injury and mechanical ventilation time.
Conclusion
A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content.
Chloride associated with morbidity but not mortality The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.BACKGROUNDThe objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.Systematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high-chloride (ion concentration greater than 111 mmol/l up to and including 154 mmol/l) or lower-chloride (concentration 111 mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed-effect modelling.METHODSSystematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high-chloride (ion concentration greater than 111 mmol/l up to and including 154 mmol/l) or lower-chloride (concentration 111 mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed-effect modelling.The search identified 21 studies involving 6253 patients. High-chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1.64, 95 per cent c.i. 1.27 to 2.13; P < 0.001) and hyperchloraemia/metabolic acidosis (RR 2.87, 1.95 to 4.21; P < 0.001). High-chloride fluids were also associated with greater serum chloride (MD 3.70 (95 per cent c.i. 3.36 to 4.04) mmol/l; P < 0.001), blood transfusion volume (SMD 0.35, 0.07 to 0.63; P = 0.014) and mechanical ventilation time (SMD 0.15, 0.08 to 0.23; P < 0.001). Sensitivity analyses excluding heavily weighted studies resulted in non-statistically significant effects for acute kidney injury and mechanical ventilation time.RESULTSThe search identified 21 studies involving 6253 patients. High-chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1.64, 95 per cent c.i. 1.27 to 2.13; P < 0.001) and hyperchloraemia/metabolic acidosis (RR 2.87, 1.95 to 4.21; P < 0.001). High-chloride fluids were also associated with greater serum chloride (MD 3.70 (95 per cent c.i. 3.36 to 4.04) mmol/l; P < 0.001), blood transfusion volume (SMD 0.35, 0.07 to 0.63; P = 0.014) and mechanical ventilation time (SMD 0.15, 0.08 to 0.23; P < 0.001). Sensitivity analyses excluding heavily weighted studies resulted in non-statistically significant effects for acute kidney injury and mechanical ventilation time.A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content.CONCLUSIONA weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content. The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting. Systematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high-chloride (ion concentration greater than 111 mmol/l up to and including 154 mmol/l) or lower-chloride (concentration 111 mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed-effect modelling. The search identified 21 studies involving 6253 patients. High-chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1.64, 95 per cent c.i. 1.27 to 2.13; P < 0.001) and hyperchloraemia/metabolic acidosis (RR 2.87, 1.95 to 4.21; P < 0.001). High-chloride fluids were also associated with greater serum chloride (MD 3.70 (95 per cent c.i. 3.36 to 4.04) mmol/l; P < 0.001), blood transfusion volume (SMD 0.35, 0.07 to 0.63; P = 0.014) and mechanical ventilation time (SMD 0.15, 0.08 to 0.23; P < 0.001). Sensitivity analyses excluding heavily weighted studies resulted in non-statistically significant effects for acute kidney injury and mechanical ventilation time. A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content. Background The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting. Methods Systematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high-chloride (ion concentration greater than 111mmol/l up to and including 154mmol/l) or lower-chloride (concentration 111mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed-effect modelling. Results The search identified 21 studies involving 6253 patients. High-chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1·64, 95 per cent c.i. 1·27 to 2·13; P<0·001) and hyperchloraemia/metabolic acidosis (RR 2·87, 1·95 to 4·21; P<0·001). High-chloride fluids were also associated with greater serum chloride (MD 3·70 (95 per cent c.i. 3·36 to 4·04) mmol/l; P<0·001), blood transfusion volume (SMD 0·35, 0·07 to 0·63; P=0·014) and mechanical ventilation time (SMD 0·15, 0·08 to 0·23; P<0·001). Sensitivity analyses excluding heavily weighted studies resulted in non-statistically significant effects for acute kidney injury and mechanical ventilation time. Conclusion A weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content. Chloride associated with morbidity but not mortality |
| Author | Shaw, A. D. Krajewski, M. L. Paluszkiewicz, S. M. Schermer, C. R. Raghunathan, K. |
| Author_xml | – sequence: 1 givenname: M. L. surname: Krajewski fullname: Krajewski, M. L. organization: Department of Anesthesiology, Duke University Medical Center, North Carolina, USA – sequence: 2 givenname: K. surname: Raghunathan fullname: Raghunathan, K. organization: Department of Anesthesiology, Duke University Medical Center, North Carolina, USA – sequence: 3 givenname: S. M. surname: Paluszkiewicz fullname: Paluszkiewicz, S. M. organization: Boston Strategic Partners, Boston, Massachusetts, USA – sequence: 4 givenname: C. R. surname: Schermer fullname: Schermer, C. R. organization: Baxter Healthcare Corporation, Deerfield, Illinois, USA – sequence: 5 givenname: A. D. surname: Shaw fullname: Shaw, A. D. email: andrew.shaw@vanderbilt.edu organization: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA |
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| Notes | Appendix S1 Electronic health database search terms (Word document)Fig. S1 Risk of bias graph for randomized controlled trials meeting meta-analysis inclusion criteria (Word document)Fig. S2 Risk of bias graph for non-randomized studies meeting meta-analysis inclusion criteria (Word document)Fig. S3 Analysis of intensive care unit (ICU) length of stay following volume resuscitation with high-chloride versus low-chloride intravenous fluids (Word document)Fig. S4 Analysis of hospital length of stay following volume resuscitation with high-chloride versus low-chloride intravenous fluids (Word document)Fig. S5 Serum chloride concentration following volume resuscitation with high-chloride versus low-chloride intravenous fluids (Word document)Fig. S6 Analysis of mechanical ventilation time following volume resuscitation with high-chloride versus low-chloride intravenous fluids (Word document)Fig. S7 Analysis of serum creatinine concentration following volume resuscitation with high-chloride versus low-chloride intravenous fluids (Word document)Fig. S8 Analysis of urine output following volume resuscitation with high-chloride versus low-chloride intravenous fluids (Word document)Table S1 Risk of bias of included randomized controlled trials (Word document)Table S2 Risk of bias of included non-randomized studies (Word document)Table S3 Study fluid volumes received (Word document) ArticleID:BJS9651 istex:AC44DDCDFACE38CE01CFC2BBE97905EC2254CE4A ark:/67375/WNG-7FZZDRLQ-V ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23 ObjectType-Undefined-4 |
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Early postoperative respiratory acidosis after large intravascular volume infusion of lactated Ringer's solution during major spine surgery. Anesth Analg 2002; 95: 294-298. Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg 2001; 93: 817-822. Van Zyl DG, Rheeder P, Delport E. Fluid management in diabetic-acidosis - Ringer's lactate versus normal saline: a randomized controlled trial. QJM 2012; 105: 337-343. Yunos NM, Kim IB, Bellomo R, Bailey M, Ho L, Story D et al. The biochemical effects of restricting ch 2001; 93 2014; 259 2010; 14 2004; 125 2013; 27 2013; 66 2002; 95 2013; 369 2004; 8 2004; 23 2006; 130 2008; 36 2008; 107 1999; 88 2009; 151 2008; 30 2012; 367 2008; 101 2013; 7 1993; 121 2003; 327 2012; 255 2012; 256 2005; 100 1986; 44 1992; 112 2008; 27 2013; 117 2011; 22 2012; 27 2007; 62 2008; 63 2012; 23 1999; 90 2011; 29 2001; 51 2007; 24 2007; 26 2002; 30 2012 1989; 256 2011 2000; 26 2013; 45 2009 2002; 2 1994; 49 1983; 71 2013; 382 2012; 345 2011; 39 2012; 105 2011; 8 2014; 112 2012; 308 1999 2011; 9 2014; 42 2013; 33 2004; 350 2005; 5 2014 2012; 49 2013 2003; 104 1998; 32 2012; 9 37167797 - J Clin Anesth. 2023 Sep;88:111141. doi: 10.1016/j.jclinane.2023.111141. |
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The objective of this systematic review and meta‐analysis was to assess the relationship between the chloride content of intravenous resuscitation... The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and... Background The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation... |
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| SubjectTerms | Adult Chlorides - analysis Critical Care Crystalloid Solutions Epidemiologic Methods Fluid Therapy Humans Hypertonic Solutions - chemistry Infusions, Intravenous Isotonic Solutions - chemistry Perioperative Care Rehydration Solutions - administration & dosage Rehydration Solutions - chemistry Systematic Reviews Treatment Outcome |
| Title | Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation |
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