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Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
16:31

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Published on: June 6, 2011

The ideal crystalloid - what is 'balanced'?

Thomas J Morgan1

  • 1Mater Medical Research Institute and University of Queensland, Mater Health Services, Stanley Street, South Brisbane, Brisbane, Queensland, Australia. t.morgan@uq.edu.au

Current Opinion in Critical Care
|June 8, 2013
PubMed
Summary
This summary is machine-generated.

Balanced crystalloids may improve patient outcomes by reducing chloride exposure and optimizing acid-base balance. Further research, including large clinical trials, is needed to confirm their benefits over traditional saline solutions.

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Area of Science:

  • Critical care medicine
  • Fluid resuscitation
  • Electrolyte and acid-base balance

Background:

  • Crystalloid fluid administration is common in critical care.
  • Traditional crystalloids like 0.9% sodium chloride may have adverse effects.
  • The definition and optimal composition of 'balanced crystalloids' are evolving.

Purpose of the Study:

  • To explore the current definition of balanced crystalloids.
  • To outline optimal design features and their rationale.
  • To review the evidence for their use in clinical practice.

Main Methods:

  • Literature review of contemporary definitions and research.
  • Analysis of acid-base and tonicity principles for fluid design.
  • Evaluation of evidence regarding crystalloid effects on kidney function, intracranial pressure, and mortality.

Main Results:

  • Crystalloid-induced interstitial expansion occurs with both balanced and traditional solutions.
  • Reduced chloride content may decrease kidney dysfunction and improve mortality.
  • Balanced crystalloids with a strong ion difference of 24 mEq/L achieve acid-base balance.
  • Ringer's acetate solution approximates balanced properties; acetate toxicity is not evident in volume loading.

Conclusions:

  • The evidence supporting balanced crystalloids is accumulating but not yet definitive.
  • A large randomized controlled trial comparing balanced crystalloids to 0.9% sodium chloride is warranted.
  • Further investigation is needed to establish the clinical superiority of balanced crystalloids.