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Vol. 66. Issue 1.
Pages 3-9 (January 2019)
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Vol. 66. Issue 1.
Pages 3-9 (January 2019)
Original article
Meta-analysis of the effects of normal saline on mortality in intensive care
Metaanálisis de los efectos del suero salino en la mortalidad en cuidados intensivos
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A. González-Castroa,
Corresponding author
e409@humv.es

Corresponding author.
, M. Ortiz-Lasaa, J.C. Rodriguez-Borregana, P. Escudero-Achaa, E. Chicotea, B. Suberviolaa, C. Blancoa, Y. Peñascoa, A. Jiménez Alfonsoa, J. Llorcab, T. Dierssen-Sotob
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina de la Universidad de Cantabria, Santander, Spain
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Tables (2)
Table 1. Assessment of the risk of bias in each trial using the Cochrane tool.
Table 2. Main characteristics of the studies included in the meta-analysis.
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Abstract
Introduction and objective

To evaluate, by means of a meta-analysis, the effect of normal saline on mortality in intensive care patients, when compared with the use of balanced crystalloids.

Material and method

Published controlled clinical trials, randomized and sequential prospective studies in time, evaluating the mortality when physiological saline was used in patients admitted to intensive care units. Electronic search was performed in Medline, Embase, Cochrane Library, ISI Proceedings, and Web of Science, as well as a manual search of selected references. An independent evaluation was performed by 2 investigators. Discrepancies were resolved by consensus in the working group. Contingency tables were performed, and the OR with confidence intervals of each study were obtained. Heterogeneity was assessed by I2. Publication bias was assessed using funnel plot and Egger test.

Results

A total of 8 articles were selected for the meta-analysis of mortality, which included a total of 20,684 patients. A significant association was observed between the use of saline and mortality in intensive care patients (OR 1.0972; 95% CI 1.0049–1.1979), when compared to the use of balanced crystalloids. No statistical evidence of publication bias (Egger, P=.5349) was found. In the sensitivity analysis, none of the studies substantially modified the overall outcome if it was eliminated from the meta-analysis.

Conclusions

There may be an increase in mortality associated with the use of saline in patients admitted to intensive care when comparing with the use of balanced crystalloids.

Keywords:
Normal saline
Balanced crystalloids
Meta-analysis
Mortality
Fluids
Resumen
Introducción y objetivo

Evaluar, mediante un metaanálisis, el efecto del suero salino sobre la mortalidad en los pacientes de cuidados intensivos, cuando se compara su uso con el de cristaloides balanceados.

Material y método

Se ha realizado un metaanálisis de ensayos clínicos controlados, aleatorizados y estudios prospectivos secuenciales en el tiempo, publicados, que evaluaron la mortalidad del suero salino en enfermos ingresados en unidades de cuidados intensivos. Se llevó a cabo una búsqueda electrónica en Medline, Embase, biblioteca Cochrane, ISI Proceedings y Web of Science y una búsqueda manual sobre las referencias seleccionadas. La extracción de datos fue realizada de forma independiente por 2 investigadores. Las discrepancias se resolvieron por consenso en el grupo de trabajo. El cálculo de la OR y su intervalo de confianza se realizó ponderando por el inverso de la varianza. La heterogeneidad se evaluó mediante I2. El sesgo de publicación se valoró mediante funnel plot y test de Egger.

Resultados

Se seleccionaron 8 artículos para el metaanálisis de mortalidad, que incluían un total de 20.684 pacientes. Se objetivó una asociación entre el uso de suero salino y la mortalidad en los enfermos de cuidados intensivos (OR 1,0972; IC 95%:1,0049–1,1979) cuando se comparaba con el uso de cristaloides balanceados. No se encontró evidencia de sesgo de publicación (prueba de Egger p=0,5349). En el análisis de sensibilidad ninguno de los estudios modificó sustancialmente el resultado global si se eliminaba del metaanálisis.

Conclusiones

Es posible que exista un aumento de la mortalidad asociada al empleo de suero salino en los pacientes ingresados en cuidados intensivos cuando se compara con el empleo de cristaloides balanceados.

Palabras clave:
Suero salino
Cristaloides balanceados
Metaanálisis
Mortalidad
Fluidos

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