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Odor PM, Bampoe S, Dushianthan A, et al. Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review. Perioper Med (Lond). 2018;7:27doi: 10.1186/s13741-018-0108-5.
Odor, P. M., Bampoe, S., Dushianthan, A., Bennett-Guerrero, E., Cro, S., Gan, T. J., Grocott, M. P. W., James, M. F. M., Mythen, M. G., O'Malley, C. M. N., Roche, A. M., Rowan, K., & Burdett, E. (2018). Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review. Perioperative medicine (London, England), 727. https://doi.org/10.1186/s13741-018-0108-5
Odor, Peter M, et al. "Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review." Perioperative medicine (London, England) vol. 7 (2018): 27. doi: https://doi.org/10.1186/s13741-018-0108-5
Odor PM, Bampoe S, Dushianthan A, Bennett-Guerrero E, Cro S, Gan TJ, Grocott MPW, James MFM, Mythen MG, O'Malley CMN, Roche AM, Rowan K, Burdett E. Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review. Perioper Med (Lond). 2018 Dec 13;7:27. doi: 10.1186/s13741-018-0108-5. eCollection 2018. PMID: 30559961; PMCID: PMC6291967.
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Perioper Med (Lond). 2018 Dec 13;7:27. doi: 10.1186/s13741-018-0108-5. eCollection 2018.

Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review.

Perioperative medicine (London, England)

Peter M Odor, Sohail Bampoe, Ahilanandan Dushianthan, Elliott Bennett-Guerrero, Suzie Cro, Tong J Gan, Michael P W Grocott, Michael F M James, Michael G Mythen, Catherine M N O'Malley, Anthony M Roche, Kathy Rowan, Edward Burdett

Affiliations

  1. 1Department of Anaesthesia and Critical Care, University College London, Gower St, London, WC1E 6BT UK.
  2. 2Centre for Anaesthesia and Perioperative Medicine, University College London, London, UK.
  3. 3General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  4. 4Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY USA.
  5. 5Medical Research Council Clinical Trials Unit, London, UK.
  6. 6Critical Care Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
  7. 7Department of Anaesthesia, University of Cape Town, Cape Town, South Africa.
  8. 8Department of Anaesthesia, St James's Hospital, Dublin, Ireland.
  9. 9Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA USA.
  10. 10Intensive Care National Audit & Research Centre, London, UK.
  11. 11Department of Anaesthesia, UCL Centre for Anaesthesia, London, UK.

PMID: 30559961 PMCID: PMC6291967 DOI: 10.1186/s13741-018-0108-5

Abstract

BACKGROUND: Buffered intravenous fluid preparations contain substrates to maintain acid-base status. The objective of this systematic review was to compare the effects of buffered and non-buffered fluids administered during the perioperative period on clinical and biochemical outcomes.

METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library until May 2017 and included all randomised controlled trials that evaluated buffered versus non-buffered fluids, whether crystalloid or colloid, administered to surgical patients. We assessed the selected studies for risk of bias and graded the level of evidence in accordance with Cochrane recommendations.

RESULTS: We identified 19 publications of 18 randomised controlled trials, totalling 1096 participants. Mean difference (MD) in postoperative pH was 0.05 units lower immediately following surgery in the non-buffered group (12 studies of 720 participants; 95% confidence interval (CI) 0.04 to 0.07;

CONCLUSIONS: Small effect sizes for biochemical outcomes and lack of correlated clinical follow-up data mean that robust conclusions on major morbidity and mortality associated with buffered versus non-buffered perioperative fluid choices are still lacking. Buffered fluid may have biochemical benefits, including a significant reduction in postoperative hyperchloraemia and metabolic acidosis.

Keywords: Fluid therapy; Plasma substitutes; Surgery

Conflict of interest statement

Not applicableNot applicableAuthors of this review (Elliott Bennett-Guerrero, Tong J Gan, Michael G Mythen, Catherine O’Malley) authored five of the primary studies included in this review. Michael FM

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