Accès ouvert déclaré
2021
article
Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients
Fernando G. Zampieri, Flávia Ribeiro Machado, Rodrigo Biondi, Flávio Geraldo Rezende Freitas, Viviane Cordeiro Veiga, Rodrigo C. Figueiredo, Wilson José Lovato, Cristina Prata Amêndola, Ary Serpa Neto, Jorge L. R. Paranhos, Marco A.V. Guedes, Eraldo A. Lúcio, Lúcio C. Oliveira-Júnior, Thiago Lisboa, Fábio Holanda Lacerda, Israel Silva Maia, Cíntia Magalhães Carvalho Grion, Murillo Santucci César de Assunção, Airton L. O. Manoel, João Manoel Silva, Péricles Almeida Delfino Duarte, Rafael Marques Soares, Tamiris Abait Miranda, Lucas Martins de Lima, Rodrigo M. Gurgel, Denise Paisani, Thiago Domingos Corrêa, Luciano César Pontes Azevedo, John A. Kellum, Lucas Petri Damiani, Nilton Brandão da Silva, Alexandre Biasi Cavalcanti, Renato Bueno Chaves, Amanda Ribeiro dos Santos, Vitor Salvatore Barzilai, Nathaly Fonseca Nunes, Rodrigo C. da Cunha, Elijane F. Alves, Rodrigo B. Bortolini, Cintia L. Sartori, Eduardo S. Marques, Maria Auxiliadora de Sousa, Danieri Y. V. Tomotani, Bruno G. Dantas, Leonardo Carvalho Palma, Fabio Laurindo Silva, Luciana Coelho Sanches, Fernanda A. M. Scuoteguazza, Ligia Z. de Britto, Ary Serpa, Niklas Söderberg Campos, Fábio Barlem Hohmann, Guilherme Benfatti Olivato, Iany G. da Silva, Adilson de C. Meireles, Juliana Chaves Coelho, Maiko Moura Silveira, Agnes C. Lisboa, Luíz Carlos Santana Passos, Daniela C. Dorta, Ramana A. Rangel, Eraldo de Azevedo Lúcio, Eduardo B. Tondo, Pablo A.A. Vaz, Paula K. de Oliveira, Lúcio Couto de Oliveira, Paulo H.P. Ferreira, Patrick Harrison Santana Sampaio, Maurício G.S. Serra, Caroline Fachini, André P. Torelly, Alldren Souza, Eliana V. N. Martins, Bruno Adler Maccagnan Pinheiro Besen, Carlos Eduardo Brandão, Flávio W.F. Melo, Flávio A. dos Santos, Cássio Luis Zandonai, Eduardo Berbigier, Josiane Festti, Ana Luiza Mezzaroba, José Andrade, Marianne Camargo, Adriano F. Teixeira, José de S. Andrade, Michele Maria Gonçalves de Godoy, Andréia de F. T. de Mendonça, Mara L.F.S. Mendes, Renata C.I.C. Beltrão, Edson Romano, Marcelo Luz Pereira Romano, André Falcão Pedrosa Costa, Jorge Farran, Felipe Dal‐Pizzol, Danusa Damásio, Renata C. Gonçalves, Luiz de F. Ferreira, Rafael Lessa da Costa, Kellen Lopes, Miquéias M.L. Silva, Douglas L.A.B. de Matos, Renata de A. Marques, Glauco Adrieno Westphal, Miriam Machado, Juliano Ramos, Luíz Marcelo Sá Malbouisson, Bruno N. Lucena, Marlus M. Thompson, Lanese Medeiros de Figueiredo, Luana Feitosa Mourão, Thiago Santos Garcês, Israel da S. Maia, Jaqueline F. Rohr, Fernanda Fontanela, Cassia P. B. Martins, Álvaro Réa-Neto, Fernanda Baeumle Reese, Mirella Cristine de Oliveira, André Luiz Nunes Gobatto, Luciana S. de Mattos, Carolaine B. de Oliveira, Meton S. de Alencar, Jussara Alencar Arraes, João G.T. Alves, Thiago C. De Morais, Antônio A. P. Fagundes, Roberta T. Tallarico, Thais Coutinho, Ronald Torres, Fernando J. S. Ramos, Fernanda C. Athalla, Maurício Henrique Claro dos Santos, Paulo Maurício Garcia Nosé, Cássia Righy Shinotsuka, Pedro Kurtz, Bruno Guimarães, Luciana Guilhermino Pereira, Raquel B. Jupato, Bruno de Arruda Bravim, Marcos Freitas Knibel, Allan S. da Silva, Vinícius G. de Luca, Niklas Soderberg, Roseny dos Reis Rodrigues, Luis E.P. Pfingsten, Cassiano Teixeira, José H.D. Barth, Giselle C. Pratini, Luiz Dalfior, Márcio H. Kai, S Blecher, Hugo C. A. Urbano, Lucas L. Carvalho, Danielle C. A. Moreira, Ana L. S. Bernardes, Vandack Nobre, Paula Frizera Vassallo, Cecilia Gómez Ravetti, Ho Y. Li, Vivian Vieira Tenório Sales, Renata Guazzelli, Rafael David de Oliveira, Leandro Pozzo, Leandro Utino Taniguchi, Pedro Vitale Mendes, Suzana M Lobo, Ana B. B. Camacho, Pablo Oscar Tomba, Fred C. T. Lizidatti, Walter C. G. Baptista, Aline R. Moreira, Manoela M. de Sousa, Marcelo de Oliveira Santos, Karla Moretto, Priscilla A. de Martins, Liz M. L. de Souza, Thiago R. Sequeira, Manoel M. S. Pedrinha, Marcone L. S. da Rocha, Francisco R. V. Saleiro, Tatiana M. Clementino, Hélio Penna Guimarães, Marcos Cesar Ramos Mello, Denise Milioli Ferreira, Fernanda Alves Ferreira Gonçalves, Roberta Muriel Longo Roepke, Bruno Martins Tomazini, Sidiner Mesquita Vaz, Miria Bonjour Laviola, Roger Monteiro Alencar, Denise N. Freitas, Heitor P. Póvoas, Liliane B. S. Passos, Juliane de M. Silva
210Citations signalées, ce qui n’est pas une note de qualité
21Institutions déclarées
2Pays d’affiliation déclarés
Rattachement africain : br, us.
Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
IMPORTANCE: Intravenous fluids are used for almost all intensive care unit (ICU) patients. Clinical and laboratory studies have questioned whether specific fluid types result in improved outcomes, including mortality and acute kidney injury. OBJECTIVE: To determine the effect of a balanced solution vs saline solution (0.9% sodium chloride) on 90-day survival in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, factorial, randomized clinical trial conducted at 75 ICUs in Brazil. Patients who were admitted to the ICU with at least 1 risk factor for worse outcomes, who required at least 1 fluid expansion, and who were expected to remain in the ICU for more than 24 hours were randomized between May 29, 2017, and March 2, 2020; follow-up concluded on October 29, 2020. Patients were randomized to 2 different fluid types (a balanced solution vs saline solution reported in this article) and 2 different infusion rates (reported separately). INTERVENTIONS: Patients were randomly assigned 1:1 to receive either a balanced solution (n = 5522) or 0.9% saline solution (n = 5530) for all intravenous fluids. MAIN OUTCOMES AND MEASURES: The primary outcome was 90-day survival. RESULTS: Among 11 052 patients who were randomized, 10 520 (95.2%) were available for the analysis (mean age, 61.1 [SD, 17] years; 44.2% were women). There was no significant interaction between the 2 interventions (fluid type and infusion speed; P = .98). Planned surgical admissions represented 48.4% of all patients. Of all the patients, 60.6% had hypotension or vasopressor use and 44.3% required mechanical ventilation at enrollment. Patients in both groups received a median of 1.5 L of fluid during the first day after enrollment. By day 90, 1381 of 5230 patients (26.4%) assigned to a balanced solution died vs 1439 of 5290 patients (27.2%) assigned to saline solution (adjusted hazard ratio, 0.97 [95% CI, 0.90-1.05]; P = .47). There were no unexpected treatment-related severe adverse events in either group. CONCLUSION AND RELEVANCE: Among critically ill patients requiring fluid challenges, use of a balanced solution compared with 0.9% saline solution did not significantly reduce 90-day mortality. The findings do not support the use of this balanced solution. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02875873.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients
- Date Crossref
- 07/09/2021
- Éditeur
- American Medical Association (AMA)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Les institutions déclarées
Une affiliation ne permet pas de déduire la nationalité d’un auteur.
Les sujets associés
Trauma, Hemostasis, Coagulopathy, ResuscitationHemodynamic Monitoring and TherapyAcute Kidney Injury Research