Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential...

Area of Science:

• Critical Care Medicine
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• Buffered crystalloid solutions are widely used in clinical settings.
• Current guidelines do not differentiate between specific buffered solution types, leading to clinical equipoise.

Purpose of the Study:

• To compare the effects of acetate-buffered versus lactate-buffered crystalloid solutions in hospitalized patients.
• To assess desirable and undesirable outcomes associated with each buffered solution type.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials (RCTs).
• Included five RCTs with 390 patients, focusing on intravenous administration in hospitalized adults and children.
• Primary outcome: all-cause short-term mortality. Analyzed hospital length of stay (LOS).
• Adhered to PRISMA, Cochrane Handbook, and GRADE methodology.

Main Results:

• No statistically significant difference in short-term mortality (RR 0.29, 95% CI 0.06-1.51) or hospital LOS (MD -1.31, 95% CI -3.66 to 1.05) between acetate- and lactate-buffered solutions.
• Evidence quality for all outcomes was rated as very low.
• Limited data on ICU LOS and vasopressor duration, precluding meta-analysis.

Conclusions:

• The current evidence comparing acetate- and lactate-buffered solutions is of very low quantity and quality.
• Further high-quality research is needed to guide clinical practice regarding buffered crystalloid solution choice.