ObjectiveTo systematically review the efficacy and safety of high-versus low-chloride content in fluid resuscitation during perioperative and critical care. MethodsDatabases 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. ResultsA 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). ConclusionCurrent 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.