Good Morning

Happy to be back on the blog

This week, we introspect about two meta analyses which analysed the outcomes associated with the use of saline versus balanced crystalloids. Balanced crystalloids are being projected and used as a safer alternative to saline which has a risk of inducing hyperchloremia.
González-Castro. Meta-analysis of the effects of normal saline on mortality in intensive care. Rev Esp Anestesiol Reanim 2018;epublished August 9th 
and
Yazan. Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis. J Intensive Care 2018;6:51 

   The first meta analysis looked at 8 RCTs involving more than 20000 patients. This meta analysis included studies which had mortality as the primary end point. The authors report a significant increase in mortality with the use of Saline although the OR is 1.0972. Other surrogate outcomes related to length of stay and AKI did not seem to be different.
  The second meta analysis also looked at nearly 19000 + patients and evaluated the effect of saline and balanced crystalloids on mortality, LOS and incidence of AKI. There did not seem to be any difference in the outcomes when saline is used in comparison to balanced crystalloids. Incidence of RRT was also not higher in the saline group.
         So, the debate seems to be unresolved. However, the odds ratio for mortality in the first Meta Analysis is not overwhelmingly against saline.
My interpretation of these two studies would be
1. Saline is not as harmful as previously thought
2. Balanced crystalloids don't seem to justify the economic impact
3. Larger studies may be needed but are likely to come out with similar results.