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...
Saved in:
| Published in: | British journal of surgery Vol. 102; no. 1; pp. 24 - 36 |
|---|---|
| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Chichester, UK
John Wiley & Sons, Ltd
01.01.2015
Oxford University Press |
| Subjects: | |
| ISSN: | 0007-1323, 1365-2168, 1365-2168 |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | 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 |
|---|---|
| Bibliography: | 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 |
| ISSN: | 0007-1323 1365-2168 1365-2168 |
| DOI: | 10.1002/bjs.9651 |