SynthesisScandinavian journal of trauma, resuscitation and emergency medicine2022
Fluid resuscitation with balanced crystalloids versus normal saline in critically ill patients: a systematic review and meta-analysis.
Synthesis in Scandinavian journal of trauma, resuscitation and emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
What it found
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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.
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.
Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children.The Cochrane database of systematic reviews · 2026Pooled it
- Agreement Between Mega-Trials and Smaller Trials: A Systematic Review and Meta-Research Analysis.JAMA network open · 2024Pooled it
- Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials.Frontiers in endocrinology · 2024Pooled it
- PractIce pattern of INtraoperative FlUid therapy in elective major gastrointeStinal cancer surgEries in India (I-INFUSE): A multicentre observational study.Indian journal of anaesthesia · 2026Article
- Balanced crystalloids versus saline for critically ill patients: an overview of systematic reviews.Critical care science · 2026Review
- Hypertriglyceridemia induced acute pancreatitis in pregnancy: a case report.Annals of medicine and surgery (2012) · 2025Article
- Effects of different sodium concentrations in fluids on brain, lung, and kidney in experimental ischemic stroke.Scientific reports · 2025Article
- Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma - A randomised controlled trial.Indian journal of anaesthesia · 2024Article
- Precision fluid and vasoactive drug therapy for critically ill patients.Pharmacotherapy · 2023Review
- Effect of Pre-Hospital Intravenous Fluids on Initial Metabolic Acid-Base Status in Trauma Patients: A Retrospective Cohort Study.Metabolites · 2023Article
- Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done.Journal of clinical medicine · 2023Review
- Article
- Comparison of Balanced Crystalloids versus Normal Saline in Critically Ill Patients: A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.Therapeutics and clinical risk management · 2023Article
- Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundIntravenous fluids are used commonly for almost all intensive care unit (ICU) patients, especially for patients in need of resuscitation. The selection and use of resuscitation fluids may affect the outcomes of patients; however, the optimal resuscitative fluid remains controversial.
methodsWe systematically searched PubMed, Embase, and CENTRAL. Studies comparing balanced crystalloids and normal saline in ICU patients were selected. We used the Cochrane Collaboration tool to assess the risk of bias in studies. The primary outcome was mortality at the longest follow-up. Secondary outcomes included the incidence of acute kidney injury (AKI) and new renal replacement therapy (RRT).
resultsA total of 35,456 patients from eight studies were included. There was no significant difference between balanced crystalloid solutions and saline in mortality (risk ratio [RR]: 0.96; 95% confidence interval [CI]:0.92-1.01). The subgroup analysis with traumatic brain injury (TBI) showed lower mortality in patients receiving normal saline (RR:1.25; 95% CI 1.02-1.54). However, in patients with non-TBI, balanced crystalloid solutions achieved lower mortality than normal saline (RR: 0.94; 95% CI 0.90-0.99). There was no significant difference in moderate to severe AKI (RR: 0.96; 95% CI 0.90-1.01) or new RRT (RR: 0.94; 95% CI 0.84-1.04).
conclusionsCompared with normal saline, balanced crystalloids may not improve the outcomes of mortality, the incidence of AKI, and the use of RRT for critically ill patients. However, balanced crystalloids reduce the risk of death in patients with non-TBI but increase the risk of death in those with TBI. Large-scale rigorous randomized trials with better designs are needed, especially for specific patient populations.
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Registered trials
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 OpenQuestion graph.