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2017, Number 3

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Med Crit 2017; 31 (3)

Balanced solutions: chlorine the «new villain»

Sánchez DJS, Monares ZE, Meneses OC, Rodríguez MEA, García MRC, Peniche MKG, Huanca PJM, Calyeca SMV

Language: Spanish
References: 36
Page: 152-158
PDF size: 166.09 Kb.


ABSTRACT

The consequences of resuscitation with liquids are usually minimized and accepted as a «necessary evil», in most cases their origin is iatrogenic. Recently much attention has been paid to balanced solutions which have a quantity of electrolytes more similar to human plasma than other types of solutions. The objective of this review is to know the pathophysiological aspects and current evidence regarding the use of balanced solutions in critically ill patients. Highlight the deleterious effects of hyperchloremia and its association with poor results. To understand how balanced solutions work we must know the Stewart Model for acid-base alterations. The interest in hyperchloremia is due to the fact that the administration of solutions is the most common maneuver in acute medicine and in turn the saline solution 0.9% the liquid mostly administered. The saline solution 0.9% can become a «problem» and not a «solution» if we do not select the right patient. Balanced solutions are an option, but not a solution in different populations of critically ill patients.


REFERENCES

  1. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369:1243-1251.

  2. Kellum JA. Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: Improved short-term survival and acid-base balance with Hextend compared with saline. Crit Care Med. 2002;30:300-305.

  3. Garnacho MJ, Fernández ME, Ferrer RR, Lorente JA, Ruiz SS, Artigas A. Cristaloides y coloides en la reanimación del paciente crítico. Med Intensiva. 2015;39:303-315.

  4. Mendes PV, Zampieri FG, Park M. Is there a role for balanced solutions in septic patients? Shock. 2017;47:30-34.

  5. Van Regenmortel N, Jorens PG, Malbrain M. Fluid management before, during and after elective surgery. Curr Opin Crit Care. 2014;20:390-395.

  6. Sánchez DJ, Meneses OC, Monares ZE, Torres GA, Aguirre SJ, Franco GJ. La diferencia de iones fuertes (DIF) calculada por el método de Fencl-Stewart simplificado es un predictor de mortalidad en pacientes con choque séptico. Archivos de Medicina de Urgencia de México. 2014;6:5-11.

  7. Kaplan LJ, Cheung NH, Maerz L, Lui F, Schuster K, Luckianow G, et al. A physicochemical approach to acid-base balance in critically ill trauma patients minimizes errors and reduces inappropriate plasma volume expansion. J Trauma. 2009;66:1045-1051.

  8. Adrogue HJ, Gennari FJ, Galla JH, Madias NE. Assessing acid–base disorders. Kidney Int. 2009;76:1239-1247.

  9. Nagaoka D, Nassar JA, Maciel AT, Taniguchi LU, Noritomi DT, Azevedo LC, et al. The use of sodium-chloride difference and chloride-sodium ratio as strong ion difference surrogates in the evaluation of metabolic acidosis in critically ill patients. J Crit Care. 2010;25:525-531.

  10. Deutschman CS, Neligan PJ. Evidence-based practice of critical care. Copyright # 2010 by Saunders, an imprint of Elsevier Inc.

  11. Van Regenmortel N, Verbrugghe W, Van den Wyngaert T, Jorens PG. Impact of chloride and strong ion difference on ICU and hospital mortality in a mixed intensive care population. Ann Intensive Care. 2016;6:91.

  12. Carlesso E, Maiocchi G, Tallarini F, Polli F, Valenza F, Cadringher P. The rule regulating pH changes during crystalloid infusion. Intensive Care Med. 2011;37:461-468.

  13. Santi M, Lava S, Camozzi P, Giannini O, Milani GP, Simonetti GD et al. The great fluid debate: saline or so-called “balanced” salt solutions? Ital J Pediatr. 2015;25:41-47.

  14. Kaplana LJ, Kellum JA. Fluids, pH, ions and electrolytes. Curr Opin Crit Care. 2010;16(4):323-333.

  15. Handy JM, Soni N. Physiological effects of hyperchloraemia and acidosis. Br J Anaesth. 2008;101:141-150.

  16. Sánchez DJ, Monares ZE, Rodríguez ZC, Díaz EA. Protocolos de reanimación en choque séptico. An Med (Mex). 2015;60:261-65.

  17. Boniatti MM, Cardoso PR, Castilho RK, Vieira SR. Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study. J Crit Care. 2011;26(2):175-179.

  18. Shaw AD, Raghunathan K, Peyerl FW, Munson SH, Paluszkiewicz SM, Schermer CR. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med. 2014;40:1897-1905.

  19. Roquilly A, Loutrel O, Cinotti R, Rosenczweig E, Flet L, Mahe PJ, et al. Balanced versus chloride-rich solutions for fluid resuscitation in brain-injured patients: a randomised double-blind pilot study. Crit Care. 2013;17:R77.

  20. Lehmann L, Bendel S, Uehlinger DE, Takala J, Schafer M, Reinert M, et al. Randomized, double-blind trial of the effect of fluid composition on electrolyte, acid-base and fluid homeostasis in patients early after subarachnoid hemorrhage. Neurocrit Care. 2013;18:5-12.

  21. Alvis-Miranda HR, Castellar-Leones SM, Moscote-Salazar LR. Intravenous fluid therapy in traumatic brain injury and decompressive craniectomy. Bull Emerg Trauma. 2014;2:3-14.

  22. Rowell SE, Fair KA, Barbosa RR, Watters JM, Bulger EM, Holcomb JB, et al. The impact of pre-hospital administration of lactated ringer’s solution versus normal saline in patients with traumatic brain injury. J Neurotrauma. 2016;33:1054-1059.

  23. Rochwerg B, Alhazzani W, Sindi A, Heels-Ansdell D, Thabane L, Fox-Robichaud A, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med. 2014;161:347-55.

  24. Raghunathan K, Shaw A, Nathanson B, Stürmer T, Brookhart A, Stefan MS, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med. 2014;42:1585-1559.

  25. Yunos NM, Bellomo R, Glassford N, Sutcliffe H, Lam Q, Bailey M. Chloride-liberal vs. chloriderestrictive intravenous fluid administration and acute kidney injury: an extended analysis. Intensive Care Med. 2015;41:257-264.

  26. Young JB, Utter GH, Schermer CR, Galante JM, Phan HH, Yang Y, et al. Saline versus Plasma-Lyte A in initial resuscitation of trauma patients: a randomized trial. Ann Surg. 2014;259:255-262.

  27. Lee JY, Hong TH, Lee KW, Jung MJ, Lee JG, Lee SH. Hyperchloremia is associated with 30-day mortality in major trauma patients: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2016;24:117.

  28. Todd SR, Malinoski D, Muller P, Schreiber MA. Lactated Ringer’s is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. J Trauma. 2007;62:636-639.

  29. McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg. 2013;117:412-421.

  30. Kuca T, Butler MB, Erdogan M, Green RS. A comparison of balanced and unbalanced crystalloid solutions in surgery patient outcomes. Anaesth Crit Care Pain Med. 2016;16:30117-30115.

  31. Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg. 2015;102:24-36.

  32. Young P, Bailey M, Beasley R, Henderson S, Mackle D, McArthur C, et al. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: The SPLIT randomized clinical trial. JAMA. 2015;314:1701-1710.

  33. Sen A, Keener C, Sileanu FE, Foldes E, Clermont G, Murugan R, et al. Chloride content of fluids used for large-volume resuscitation is associated with reduced survival. Crit Care Med. 2017;45(2):e146-e153.

  34. Semler MW, Wanderer JP, Ehrenfeld JM, Stollings JL, Self WH, Siew ED, et al. Balanced crystalloids versus saline in the Intensive Care Unit: the salt randomized trial. Am J Respir Crit Care Med. 2017; 195 (10): 1362-1372.

  35. Raghunathan K, Nailer P, Konoske R. What is the ideal crystalloid? Curr Opin Crit Care. 2015;21:309-314.

  36. Zampieri FG, Ranzani OT, Pontes Azevedo LC, Martins ID, Kellum JA, Libório AB. Lactated ringer is associated with reduced mortality and less acute kidney injury in critically ill patients: a retrospective cohort analysis. Crit Care Med. 2016; 44:2163-2170.




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