Balanced crystalloids versus saline for critically ill patients: an overview of systematic reviews.

OBJECTIVE

To provide an overview of the evidence comparing the use of balanced crystalloids and normal saline in critically ill patients.

METHODS

A comprehensive literature search was conducted in PubMed®, Embase, and Cochrane databases through July 2024. Systematic reviews with meta-analyses comparing balanced crystalloids versus normal saline in critically ill patients were included. The methodological quality of the included reviews was assessed using the AMSTAR-2 tool.

RESULTS

Fourteen systematic reviews published between 2018 and 2024 met the inclusion criteria. Key clinical outcomes evaluated included mortality, acute kidney injury, and initiation of renal replacement therapy. Patient subgroups analyzed encompassed sepsis, trauma, hypovolemia, traumatic brain injury, postoperative status (cardiac and non-cardiac), and elderly populations. The methodological quality assessment of reviews using AMSTAR-2 revealed that most reviews had critical weaknesses in one or more domains. Quality appraisal revealed that one review had no critical domain weaknesses, while 13 reviews exhibited limitations in these domains. Evidence synthesis indicated a small benefit of balanced crystalloids compared to normal saline, especially among patients with sepsis and those without traumatic brain injury.

CONCLUSION

This overview of systematic reviews suggests a small clinical advantage of balanced crystalloids over normal saline in critically ill patients, particularly in subgroups such as those with sepsis.