High-versus Low-chloride Content in Fluid Resuscitation: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIZhen ,  ZOUYuan , ZHUYA-ping , PENGHAN-fei

Department of Anesthesiology, Haiyan Hospital of Traditional Chinese Medicine of Zhejiang, Jiaxing 314300, China;

Corresponding author：

ZOUYuan, Email: zouyuanmazui@163.com

Keywords：

Fluid resuscitation; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160145

Video：

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Objective To systematically review the efficacy and safety of high-versus low-chloride content in fluid resuscitation during perioperative and critical care. Methods Databases including The Cochrane Library (Issue 5, 2015), Web of Science, PubMed, CNKI, VIP, CBM and WanFang Data were searched to collect relevant randomized controlled trials (RCTs) about high-versus low-chloride content in fluid resuscitation from inception to May 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.2 software. Results A total of 15 RCTs involving 772 participants were included. The results of meta-analysis indicated that there were no significant differences in mortality (RR=1.30, 95% CI 0.59 to 2.89, P=0.52), incidence of acute kidney injury (RR=1.66, 95% CI 0.83 to 3.31, P=0.15), the level of serum creatinine (MD=0.05, 95% CI-0.06 to 0.15, P=0.38), urine output (MD=0.61, 95% CI-1.11 to-2.33, P=0.48), transfusion volume (MD=86.01, 95% CI-37.80 to 209.82, P=0.17), hospital length of stay (LOS) (MD=-0.27, 95% CI-1.11 to 0.58, P=0.54) and ICU LOS (MD=-0.97, 95% CI-3.31 to 1.37, P=0.42) between the high-chloride content group and the low-chloride content group. While the level of serum chlorine in the high-chloride content group was higher than that in the low-chloride content group (MD=5.40, 95% CI 1.68 to 9.12, P=0.004). Conclusion Current evidence shows, there is no difference between high-versus low-chloride content in fluid resuscitation during perioperative and critical care. Due to the limited quality and quantity of the included studies, more high quality studies are need to verify the above conclusion.

Citation： LIZhen, ZOUYuan, ZHUYA-ping, PENGHAN-fei. High-versus Low-chloride Content in Fluid Resuscitation: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 939-946. doi: 10.7507/1672-2531.20160145 Copy

1.	Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med, 2013, 369(25):2462-2463.
2.	Finfer S, Liu B, Taylor C, et al. Resuscitation fluid use in critically ill adults:an international cross-sectional study in 391 intensive care units. Crit Care, 2010, 14(5):R185.
3.	Guidet B, Soni N, Della Rocca G, et al. A balanced view of balanced solutions. Crit Care, 2010, 14(5):325.
4.	Lobo DN, Awad S. Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent 'pre-renal' acute kidney injury?:con. Kidney Int, 2014, 86(6):1096-1105.
5.	Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med, 2004, 350(22):2247-2256.
6.	Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med, 2012, 367(20):1901-1911.
7.	Handy JM, Soni N. Physiological effects of hyperchloraemia and acidosis. Br J Anaesth, 2008, 101(2):141-150.
8.	Powell-Tuck J, Gosling P, Lobo1 DN, et al. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP). British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP); 2011. Aviable at: http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf[accessed 20 October 2013].
9.	Chowdhury AH, Cox EF, Francis ST, et al. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg, 2012, 256(1):18-24.
10.	Kellum JA, Song M, Almasri E. Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest, 2006, 130(4):962-967.
11.	Kellum JA, Song M, Venkataraman R. Effects of hyperchloremic acidosis on arterial pressure and circulating inflammatory molecules in experimental sepsis. Chest, 2004, 125(1):243-248.
12.	McCluskey SA, Karkouti K, Wijeysundera D, et al. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality:a propensity-matched cohort study. Anesth Analg, 2013, 117(2):412-421.
13.	Burdett E, Dushianthan A, Bennett-Guerrero E, et al. Perioperative buffered versus non-buffered fluid administration for surgery in adults. Cochrane Database Syst Rev, 2012, 12:CD004089.
14.	Orbegozo Cortes D, Rayo Bonor A, Vincent JL. Isotonic crystalloid solutions:a structured review of the literature. Br J Anaesth, 2014, 112(6):968-981.
15.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at www.cochranehandbook.org.
16.	Review Manager (RevMan)[Computer program]. Version 5.3. Copenhagen:The Nordic Cochrane Centre, The Cochrane Collaboration, 2012. Aviable at:http://tech.cochrane.org/revman/download.
17.	Scheingraber S, Rehm M, Sehmisch C, et al. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology, 1999, 90(5):1265-1270.
18.	Waters JH, Gottlieb A, Schoenwald P, et al. 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(4):817-822.
19.	Takil A, Eti Z, Irmak P, et al. Early postoperative respiratory acidosis after large intravascular volume infusion of lactated ringer's solution during major spine surgery. Anesth Analg, 2002, 95(2):294-298.
20.	O'Malley CM, Frumento RJ, Hardy MA, et al. A randomized, double-blind comparison of lactated Ringer's solution and 0.9% NaCl during renal transplantation. Anesth Analg, 2005, 100(5): 1518-1524.
21.	Cho YS, Lim H, Kim SH. Comparison of lactated Ringer's solution and 0.9% saline in the treatment of rhabdomyolysis induced by doxylamine intoxication. Emerg Med J, 2007, 24(4):276-280.
22.	Hadimioglu N, Saadawy I, Saglam T, et al. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesth Analg, 2008, 107(1):264-269.
23.	Khajavi MR, Etezadi F, Moharari RS, et al. Effects of normal saline vs. lactated ringer's during renal transplantation. Ren Fail, 2008, 30(5):535-539.
24.	Mahler SA, Conrad SA, Wang H, et al. Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis. Am J Emerg Med, 2011, 29(6): 670-674.
25.	Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol, 2011, 9(8):710-717.
26.	Hasman H, Cinar O, Uzun A, et al. A randomized clinical trial comparing the effect of rapidly infused crystalloids on acid-base status in dehydrated patients in the emergency department. Int J Med Sci, 2012, 9(1):59-64.
27.	Mahajan V, Sajan SS, Sharma A, et al. Ringers lactate vs Normal saline for children with acute diarrhea and severe dehydration-a double blind randomized controlled trial. Indian Pediatr, 2012, 49(12):963-968.
28.	Modi MP, Vora KS, Parikh GP, et al. A comparative study of impact of infusion of Ringer's Lactate solution versus normal saline on acid-base balance and serum electrolytes during live related renal transplantation. Saudi J Kidney Dis Transpl, 2012, 23(1):135-137.
29.	Van Zyl DG, Rheeder P, Delport E. Fluid management in diabeticacidosis--Ringer's lactate versus normal saline:a randomized controlled trial. QJM, 2012, 105(4):337-343.
30.	Kim SY, Huh KH, Lee JR, et al. Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods. Transplant Proc, 2013, 45(6):2191-2196.
31.	Young JB, Utter GH, Schermer CR, et al. Saline versus Plasma-Lyte A in initial resuscitation of trauma patients:a randomized trial. Ann Surg, 2014, 259(2):255-262.
32.	Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA, 2012, 308(15):1566-1572.
33.	Shaw AD, Bagshaw SM, Goldstein SL, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg, 2012, 255(5):821-829.
34.	Chua HR, Venkatesh B, Stachowski E, et al. Plasma-Lyte 148 vs 0.9% saline for fluid resuscitation in diabetic ketoacidosis. J Crit Care, 2012, 27(2):138-145.
35.	Cieza JA, Hinostroza J, Huapaya JA, et al. Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea. J Infect Dev Ctries, 2013, 7(7): 528-532.
36.	Berger MM, Pictet A, Revelly JP, et al. Impact of a bicarbonated saline solution on early resuscitation after major burns. Intensive Care Med, 2000, 26(9):1382-1385.
37.	Zunini GS, Rando KA, Cox RG. Fluid replacement in craniofacial pediatric surgery:normal saline or ringer's lactate? J Craniofac Surg, 2011, 22(4):1370-1374.
38.	低血容量休克复苏指南(2007).中国实用外科杂志, 2007, 27(8): 581-587.
39.	中华医学会重症医学分会2012-2013.中华医学信息导报, 2013, 28(9):10.
40.	杜奕奇. 2013年中国急性胰腺炎诊治指南解读.中国实用内科杂志, 2014, 34(9):859-861.
41.	Soreide K, Alderson D, Bergenfelz A, et al. Strategies to improve clinical research in surgery through international collaboration. Lancet, 2013, 382(9898):1140-1151.
42.	Australian New Zealand Clinical Trials Registry (ANZCTR). 0.9% Salinevs.Plasma-Lyte 148 for Intensive Care Fluid Therapy (The SPLIT Study); 2013. Aviable at:https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365460[accessed 22 May 2014].
43.	Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med, 2010, 152(11):726-732.
44.	张吉新, 李士华, 毕宝林, 等.创伤失血性休克的液体复苏.创伤外科杂志, 2008, 10(3):200-202.
45.	区金锐, 侯宝华.重症急性胰腺炎早期液体复苏.中国实用外科杂志, 2007, 27(8):613-615.
46.	毛恩强, 许志伟.重症急性胰腺炎(Ⅱ型)发病72h内液体复苏的若干问题.中国实用外科杂志, 2012, 32(7):545-548.

1. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med, 2013, 369(25):2462-2463.
2. Finfer S, Liu B, Taylor C, et al. Resuscitation fluid use in critically ill adults:an international cross-sectional study in 391 intensive care units. Crit Care, 2010, 14(5):R185.
3. Guidet B, Soni N, Della Rocca G, et al. A balanced view of balanced solutions. Crit Care, 2010, 14(5):325.
4. Lobo DN, Awad S. Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent 'pre-renal' acute kidney injury?:con. Kidney Int, 2014, 86(6):1096-1105.
5. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med, 2004, 350(22):2247-2256.
6. Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med, 2012, 367(20):1901-1911.
7. Handy JM, Soni N. Physiological effects of hyperchloraemia and acidosis. Br J Anaesth, 2008, 101(2):141-150.
8. Powell-Tuck J, Gosling P, Lobo1 DN, et al. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP). British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP); 2011. Aviable at: http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf[accessed 20 October 2013].
9. Chowdhury AH, Cox EF, Francis ST, et al. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte(R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg, 2012, 256(1):18-24.
10. Kellum JA, Song M, Almasri E. Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest, 2006, 130(4):962-967.
11. Kellum JA, Song M, Venkataraman R. Effects of hyperchloremic acidosis on arterial pressure and circulating inflammatory molecules in experimental sepsis. Chest, 2004, 125(1):243-248.
12. McCluskey SA, Karkouti K, Wijeysundera D, et al. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality:a propensity-matched cohort study. Anesth Analg, 2013, 117(2):412-421.
13. Burdett E, Dushianthan A, Bennett-Guerrero E, et al. Perioperative buffered versus non-buffered fluid administration for surgery in adults. Cochrane Database Syst Rev, 2012, 12:CD004089.
14. Orbegozo Cortes D, Rayo Bonor A, Vincent JL. Isotonic crystalloid solutions:a structured review of the literature. Br J Anaesth, 2014, 112(6):968-981.
15. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at www.cochranehandbook.org.
16. Review Manager (RevMan)[Computer program]. Version 5.3. Copenhagen:The Nordic Cochrane Centre, The Cochrane Collaboration, 2012. Aviable at:http://tech.cochrane.org/revman/download.
17. Scheingraber S, Rehm M, Sehmisch C, et al. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology, 1999, 90(5):1265-1270.
18. Waters JH, Gottlieb A, Schoenwald P, et al. 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(4):817-822.
19. Takil A, Eti Z, Irmak P, et al. Early postoperative respiratory acidosis after large intravascular volume infusion of lactated ringer's solution during major spine surgery. Anesth Analg, 2002, 95(2):294-298.
20. O'Malley CM, Frumento RJ, Hardy MA, et al. A randomized, double-blind comparison of lactated Ringer's solution and 0.9% NaCl during renal transplantation. Anesth Analg, 2005, 100(5): 1518-1524.
21. Cho YS, Lim H, Kim SH. Comparison of lactated Ringer's solution and 0.9% saline in the treatment of rhabdomyolysis induced by doxylamine intoxication. Emerg Med J, 2007, 24(4):276-280.
22. Hadimioglu N, Saadawy I, Saglam T, et al. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesth Analg, 2008, 107(1):264-269.
23. Khajavi MR, Etezadi F, Moharari RS, et al. Effects of normal saline vs. lactated ringer's during renal transplantation. Ren Fail, 2008, 30(5):535-539.
24. Mahler SA, Conrad SA, Wang H, et al. Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis. Am J Emerg Med, 2011, 29(6): 670-674.
25. Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol, 2011, 9(8):710-717.
26. Hasman H, Cinar O, Uzun A, et al. A randomized clinical trial comparing the effect of rapidly infused crystalloids on acid-base status in dehydrated patients in the emergency department. Int J Med Sci, 2012, 9(1):59-64.
27. Mahajan V, Sajan SS, Sharma A, et al. Ringers lactate vs Normal saline for children with acute diarrhea and severe dehydration-a double blind randomized controlled trial. Indian Pediatr, 2012, 49(12):963-968.
28. Modi MP, Vora KS, Parikh GP, et al. A comparative study of impact of infusion of Ringer's Lactate solution versus normal saline on acid-base balance and serum electrolytes during live related renal transplantation. Saudi J Kidney Dis Transpl, 2012, 23(1):135-137.
29. Van Zyl DG, Rheeder P, Delport E. Fluid management in diabeticacidosis--Ringer's lactate versus normal saline:a randomized controlled trial. QJM, 2012, 105(4):337-343.
30. Kim SY, Huh KH, Lee JR, et al. Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods. Transplant Proc, 2013, 45(6):2191-2196.
31. Young JB, Utter GH, Schermer CR, et al. Saline versus Plasma-Lyte A in initial resuscitation of trauma patients:a randomized trial. Ann Surg, 2014, 259(2):255-262.
32. Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA, 2012, 308(15):1566-1572.
33. Shaw AD, Bagshaw SM, Goldstein SL, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg, 2012, 255(5):821-829.
34. Chua HR, Venkatesh B, Stachowski E, et al. Plasma-Lyte 148 vs 0.9% saline for fluid resuscitation in diabetic ketoacidosis. J Crit Care, 2012, 27(2):138-145.
35. Cieza JA, Hinostroza J, Huapaya JA, et al. Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea. J Infect Dev Ctries, 2013, 7(7): 528-532.
36. Berger MM, Pictet A, Revelly JP, et al. Impact of a bicarbonated saline solution on early resuscitation after major burns. Intensive Care Med, 2000, 26(9):1382-1385.
37. Zunini GS, Rando KA, Cox RG. Fluid replacement in craniofacial pediatric surgery:normal saline or ringer's lactate? J Craniofac Surg, 2011, 22(4):1370-1374.
38. 低血容量休克复苏指南(2007).中国实用外科杂志, 2007, 27(8): 581-587.
39. 中华医学会重症医学分会2012-2013.中华医学信息导报, 2013, 28(9):10.
40. 杜奕奇. 2013年中国急性胰腺炎诊治指南解读.中国实用内科杂志, 2014, 34(9):859-861.
41. Soreide K, Alderson D, Bergenfelz A, et al. Strategies to improve clinical research in surgery through international collaboration. Lancet, 2013, 382(9898):1140-1151.
42. Australian New Zealand Clinical Trials Registry (ANZCTR). 0.9% Salinevs.Plasma-Lyte 148 for Intensive Care Fluid Therapy (The SPLIT Study); 2013. Aviable at:https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365460[accessed 22 May 2014].
43. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med, 2010, 152(11):726-732.
44. 张吉新, 李士华, 毕宝林, 等.创伤失血性休克的液体复苏.创伤外科杂志, 2008, 10(3):200-202.
45. 区金锐, 侯宝华.重症急性胰腺炎早期液体复苏.中国实用外科杂志, 2007, 27(8):613-615.
46. 毛恩强, 许志伟.重症急性胰腺炎(Ⅱ型)发病72h内液体复苏的若干问题.中国实用外科杂志, 2012, 32(7):545-548.

Chinese Journal of Evidence-Based Medicine

High-versus Low-chloride Content in Fluid Resuscitation: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

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