[NaCl 0.9 % for volume substitution : blessing or curse?]

Current clinical practice often relies on 0.9% saline as a standard for volume substitution. However, recent findings challenge this approach due to its high chloride content. Prior research has shown that 0.9% saline can cause hyperchloremic acidosis in healthy individuals. This condition may impair renal perfusion and lead to complications. No prior work had resolved whether these effects translate to clinical outcomes in patients. Recent studies suggest that 0.9% saline may worsen outcomes in surgical and critically ill patients. This gap motivated a closer examination of its effects compared to balanced crystalloids. The need to reassess standard practices is now evident based on emerging evidence.

This review aims to evaluate the clinical impact of 0.9% saline in volume substitution. The focus is on its effects in surgical and critically ill patients. The study seeks to identify whether high chloride content contributes to adverse outcomes. It also investigates whether balanced crystalloids offer a safer alternative. The motivation stems from the lack of evidence supporting 0.9% saline as a superior choice. The review highlights the importance of reevaluating current guidelines. The goal is to inform clinical decisions based on recent findings. The study emphasizes the need for updated training and alternative strategies.

The review approach involves analyzing recent clinical studies on 0.9% saline. It synthesizes evidence from published trials comparing saline to balanced crystalloids. The authors examine outcomes such as acute kidney injury and mortality rates. They assess the physiological effects of hyperchloremic acidosis in surgical patients. The literature is evaluated for consistency in findings across different populations. The review also considers the impact on patients with preexisting renal conditions. In-house training programs are discussed as a tool for awareness and behavior change. The synthesis focuses on evidence-based implications for clinical practice.

The strongest finding is that 0.9% saline increases the risk of acute kidney injury. Studies show a higher need for renal replacement therapy in saline-treated patients. Postoperative in-hospital mortality is also elevated in saline users. No data support the superiority of 0.9% saline over balanced crystalloids. The high chloride content is linked to hyperchloremic acidosis and reduced renal perfusion. These effects are observed even in patients with hypokalemia or kidney injury. Balanced crystalloids appear to avoid these complications. The review concludes that current guidelines may not reflect the latest evidence.

The authors propose that 0.9% saline may not be the optimal choice for volume substitution. They suggest that balanced crystalloids could offer safer alternatives in clinical settings. The review highlights the need for updated guidelines based on recent evidence. The findings suggest that 0.9% saline may worsen outcomes in surgical and critical care. No prior work had resolved the lack of data supporting its use. The authors emphasize the importance of in-house training for medical staff. They propose that awareness and education can drive sustainable changes in practice. The review calls for further investigation into alternative fluid strategies.