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KMID : 0941820220320030251
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Korean Journal of Clinical Pharmacy
2022 Volume.32 No. 3 p.251 ~ p.259
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Resuscitation Fluids for Patients at High Risk of Multiple Organ Dysfunction Syndromes: A Systematic Review and Meta-analysis
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Nam Jae-Hyun
Kwack Hee-Jin
Ha Woo-Seob
Chung Jee-Eun
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Abstract
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Background: Intravenous fluid therapy is one of the most common interventions in critically ill patients. Normal saline is frequentlyused, but there have been some concerns about hyperchloremia. Due to closer to plasma composition, crystalloids have been used asalternatives to normal saline. However, the optimal choice of resuscitative fluids remains controversial.
Methods: MEDLINE,EMBASE, and CENTRAL were comprehensively searched until July 2021 to compare balanced crystalloids with normal saline incritically ill patients with the risk factors for multiple organ dysfunction syndromes (MODS).The primary endpoint was compositemortality. Secondary outcomes were acute kidney injury (AKI)/acute renal failure (ARF), and new receipt of renal replacementtherapy (RRT).
Results: A total of 1,240 studies were searched, and finally, 8 randomized controlled trials and 5 cohort studies wereincluded. In the meta-analysis of composite mortality of 30,710 patients, balanced crystalloids compared to normal saline weresignificantly associated with reduced mortality (OR 0.80, 95% CI 0.68-0.95). In AKI/ARF, balanced crystalloids had a lower riskthan normal saline (OR 0.91, 95% CI 0.84-0.99). There was no difference between balanced crystalloids and normal saline in risk ofnew receipt of RRT (OR 0.91, 95% CI 0.80-1.04).
Conclusion: In fluid resuscitation for patients at high risk of MODS, the use ofbalanced crystalloids showed a significantly lower incidence of mortality compared to normal saline.
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KEYWORD
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Balanced crystalloids, fluid resuscitation, critically ill patients, multiple organ dysfunction syndrome, mortality
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