BACKGROUND: Both saline and lactated Ringer's solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer's solution than normal saline. METHODS: The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer's solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury. RESULTS: Among 8,616 qualifying patients, 4,187 (49%) were assigned tolactated Ringer's solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer's versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I-III versus 0, occurred in 6.6% of lactated Ringer's patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful. CONCLUSIONS: In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer's or saline volume replacement. Clinicians can reasonably use either solution intraoperatively.
RCT Entities:
BACKGROUND: Both saline and lactated Ringer's solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer's solution than normal saline. METHODS: The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer's solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury. RESULTS: Among 8,616 qualifying patients, 4,187 (49%) were assigned to lactated Ringer's solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer's versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I-III versus 0, occurred in 6.6% of lactated Ringer's patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful. CONCLUSIONS: In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer's or saline volume replacement. Clinicians can reasonably use either solution intraoperatively.
Authors: J Henry Brems; Jonathan D Casey; Li Wang; Wesley H Self; Todd W Rice; Matthew W Semler Journal: J Crit Care Date: 2021-01-15 Impact factor: 4.298
Authors: Joseph Bledsoe; Ithan D Peltan; R J Bunnell; Samuel M Brown; Al Jephson; Danielle Groat; Nicholas M Levin; Emily Wilson; Jon Newbold; Gabriel V Fontaine; Joe Frandsen; David Hasleton; Paul Krakovitz; Kim Brunisholz; Todd Allen Journal: JAMA Netw Open Date: 2022-05-02
Authors: Michael G Collins; Magid A Fahim; Elaine M Pascoe; Kathryn B Dansie; Carmel M Hawley; Philip A Clayton; Kirsten Howard; David W Johnson; Colin J McArthur; Rachael C McConnochie; Peter F Mount; Donna Reidlinger; Laura Robison; Julie Varghese; Liza A Vergara; Laurence Weinberg; Steven J Chadban Journal: Trials Date: 2020-05-25 Impact factor: 2.279
Authors: M von der Forst; S Weiterer; M Dietrich; M Loos; C Lichtenstern; M A Weigand; B H Siegler Journal: Anaesthesist Date: 2021-02 Impact factor: 1.041
Authors: Maria J Colomina; Javier Ripollés-Melchor; Patricia Guilabert; José Luis Jover; Misericordia Basora; Concha Cassinello; Raquel Ferrandis; Juan V Llau; Judith Peñafiel Journal: BMC Anesthesiol Date: 2021-12-13 Impact factor: 2.217
Authors: Friedrich Mertzlufft; Franz Brettner; George J Crystal; Markus W Hollmann; Anton Kasatkin; Per-Arne Lönnqvist; Dominique Singer; Robert Sümpelmann; Volker Wenzel; Rolf Zander; Thomas Ziegenfuß Journal: Eur J Anaesthesiol Date: 2022-04-01 Impact factor: 4.330