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Acetate-buffered crystalloid fluids: Current knowledge, a systematic review.

Carmen A Pfortmueller1, Edith Fleischmann1

  • 1Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.

Journal of Critical Care
|August 3, 2016
PubMed
Summary

Acetate-buffered crystalloid fluids show benefits for microcirculation and heart function, but their impact on kidney function and survival remains unclear. Further research is needed to clarify these effects.

Keywords:
AcetateAcetate bufferedCrystalloidInfusion therapyLactate bufferedNormal saline

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Fluid Resuscitation

Background:

  • Acetate-buffered crystalloid solutions represent a novel approach to fluid resuscitation.
  • Existing knowledge on acetate primarily stems from nephrological research, particularly its use as a dialysis buffer at high doses.

Purpose of the Study:

  • To review the advantages and disadvantages of acetate-buffered crystalloid fluids compared to other crystalloid infusates.
  • To consolidate current evidence on the physiological effects of acetate-buffered solutions.

Main Methods:

  • A systematic literature search was performed using MEDLINE and the Cochrane Controlled Clinical Trials Register.
  • Identified studies focused on comparing acetate-buffered infusion solutions with other crystalloid infusates.
  • A total of 27 scientific studies were included after screening 1205 potential titles.

Main Results:

  • Acetate-buffered crystalloids appear to positively influence microcirculation, cardiac output, and contractility.
  • No instances of metabolic alkalosis were observed in human studies with acetate-buffered infusates, and potassium levels remained stable.
  • Data regarding the impact on kidney function, blood pressure maintenance, acute kidney injury rates, and survival are inconclusive or controversial.

Conclusions:

  • Acetate-buffered crystalloid solutions may offer benefits for microcirculation and cardiac function.
  • The effects on kidney function and long-term outcomes like survival require further investigation.
  • Current evidence suggests a favorable safety profile regarding metabolic alkalosis and potassium balance.