Article

Perioperative buffered versus non-buffered fluid administration for surgery in adults

Department of Anaesthesia, UCL Centre for Anaesthesia, 3rd floor Podium, University College Hospital, 235 Euston Road, London, UK, NW1 2BU.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 12/2012; 12(12):CD004089. DOI: 10.1002/14651858.CD004089.pub2
Source: PubMed

ABSTRACT

During surgery, patients are given fluids into their veins to prevent and treat dehydration and loss of blood. Some fluids consist of a simple salt solution whilst others are matched more closely to the fluid in the blood. These latter fluids are called buffered fluids because they maintain the balance of the acids and bases in the body. We searched the available literature for prospective randomized studies which compared outcomes with the use of buffered fluids and the use of non-buffered fluids when given to patients during surgery. We included 14 publications in this Cochrane review, reporting data from 13 trials with a total of 706 participants of whom 368 received buffered fluids and 338 received non-buffered fluids. The patients who received buffered fluids had an acid-base balance that was more normal than for those who received non-buffered fluids; and the need for the transfusion of some blood products was reduced. Overall, buffered fluids are a safe and effective alternative to non-buffered fluids when given into the veins of patients undergoing surgery.

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Available from: Ahil Dushianthan
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    • "Evidence is also emerging to suggest that administration of a large volume of 0.9 % saline may contribute to the development of hyperchloremic metabolic acidosis and AKI[16,17]. The use of balanced rather than non-balanced crystalloid solutions has recently been proposed as a pragmatic alternative to 0.9 % saline, but only limited evidence is currently available concerning comparable efficacy and safety of use[5,13]without demonstration of a clinical benefit in surgical patients[18,19]. Several meta-analyses, including studies conducted on heterogeneous patient groups with a low risk of complications, have been published on colloid use in surgical patients and showed no difference in terms of mortality and postoperative acute kidney injury (AKI) between crystalloids and low molecular weight HES202122. "
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    ABSTRACT: Inappropriate fluid therapy during surgery is associated with significant morbidity and mortality. Few studies have examined the effects of particular types of fluids (crystalloid or colloid solutions) in surgical patients, especially with the goal of hemodynamic optimization. Isotonic saline is the most commonly used fluid worldwide but may be associated with potential nephrotoxicity. Hydroxyethyl starch (HES) solutions are widely used in surgical patients as a component of goal-directed fluid optimization strategies, but several large multicenter studies have suggested increased rates of acute kidney injury and adverse events with the use of HES in ICU patients. Despite what may be inferred from physiological studies, the benefit and harm of 0.9 % saline and HES during hemodynamic therapy have not been clearly established in surgical patients. The FLASH trial is an investigator-initiated, prospective, multicenter, randomized, double-blinded, two-arm trial, randomizing 826 patients with moderate-to-high risk of postoperative complications to receive 6 % HES 130/0.4 or 0.9 % saline during individualized goal-directed fluid optimization. The primary outcome measure is a composite of death or major postoperative complications within 14 days following surgery. The sample size will allow the detection of a 10 % absolute between-group difference in the primary outcome measure with a type 1 error rate of 5 % and power of 95 %, assuming a 5 % mortality rate and 20 % morbidity (thus 25 % for the composite endpoint). The FLASH trial may provide important data on the efficacy and safety of commonly used fluid solutions and could have a significant impact on future treatment of surgical patients. Trial registration ClinicalTrials.gov Identifier: NCT02502773. Registered 16 June 2015.
    Full-text · Article · Dec 2015 · Trials
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    • "This suggests that balanced solutions are favored to saline considering the risk of metabolic derangements as hyperchloremic metabolic acidosis and patient morbidity, and clinical course. However, the mechanisms of some of these effects in humans remain unclear and further research on effect on morbidity and mortality is needed [76,89]. "
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    ABSTRACT: In this narrative review, an overview is given of the pros and cons of various crystalloid fluids used for infusion during initial resuscitation or maintenance phases in adult hospitalized patients. Special emphasis is given on dose, composition of fluids, presence of buffers (in balanced solutions) and electrolytes, according to recent literature. We also review the use of hypertonic solutions. We extracted relevant clinical literature in English specifically examining patient-oriented outcomes related to fluid volume and type. A restrictive fluid therapy prevents complications seen with liberal, large-volume therapy, even though restrictive fluid loading with crystalloids may not demonstrate large hemodynamic effects in surgical or septic patients. Hypertonic solutions may serve the purpose of small volume resuscitation but carry the disadvantage of hypernatremia. Hypotonic solutions are contraindicated in (impending) cerebral edema, whereas hypertonic solutions are probably more helpful in ameliorating than in preventing this condition and improving outcome. Balanced solutions offer a better approach for plasma composition than unbalanced ones, and the evidence for benefits in patient morbidity and mortality is increasing, particularly by helping to prevent acute kidney injury. Isotonic and hypertonic crystalloid fluids are the fluids of choice for resuscitation from hypovolemia and shock. The evidence that balanced solutions are superior to unbalanced ones is increasing. Hypertonic saline is effective in mannitol-refractory intracranial hypertension, whereas hypotonic solutions are contraindicated in this condition.
    Full-text · Article · Aug 2013
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    • "Similarly, crystalloid solutions formulated to approximate physiological conditions have been claimed to be therapeutically superior to normal saline [57]. This has not been supported in a systematic review of mortality and morbidity in patients [58]. To test this assumption further, we performed the analysis with different formulations of albumin and HES and obtained similar results. "
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    ABSTRACT: Background: Fluid resuscitation is widely practiced in intensive care units for the treatment of sepsis. A comparison of the evidence base of different fluids may inform therapeutic choice. Methods: The risks of mortality and morbidity (the need for renal replacement therapies (RRT)) were assessed in patients with severe sepsis. A network meta-analysis compared trials for crystalloids, albumin and hydroxyethyl starch (HES). A literature search of human randomized clinical trials was conducted in databases, the bibliographies of other recent relevant systematic reviews and data reported at recent conferences. Mortality outcomes and RRT data with the longest follow up period were compared. A Bayesian network meta-analysis assessed the risk of mortality and a pair-wise meta-analysis assessed RRT using crystalloids as the reference treatment. Results: 13 studies were identified. A fixed-effects meta-analysis of mortality data in the trials demonstrated an odds-ratio (OR) of 0.90 between crystalloids and albumin, 1.25 between crystalloids and HES and 1.40 between albumin and HES. The probability that albumin is associated with the highest survival was 96.4% followed by crystalloid at 3.6%, with a negligible probability for HES. Sub-group analyses demonstrated the robustness of this result to variations in fluid composition, study source and origin of septic shock. A random-effects pairwise comparison for the risk of RRT provided an OR of 1.52 favoring crystalloid over HES. Conclusion: Fluid therapy with albumin was associated with the highest survival benefit. The higher morbidity with HES may affect mortality and requires consideration by prescribers.
    Full-text · Article · Aug 2013
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