Balanced crystalloids versus saline for critically ill patients (BEST-Living): a systematic review and individual patient data meta-analysis
Authors' conclusion
The probability that using balanced solutions in the ICU reduces in-hospital mortality is high, although the certainty of the evidence was moderate and the absolute risk reduction was small. In patients with traumatic brain injury, using balanced solutions was associated with increased in-hospital mortality.
Study context
- Population
- Adult patients in intensive care units (ICUs)
- Participants
- 34,685 patients · 6 RCTs
- Comparison
- Balanced crystalloids vs saline
- Balanced solutionsn = 17,407
- Salinen = 17,278reference
- Outcome
- In-hospital mortality
Methodological detailsBayesian regression models, individually randomised and cluster-randomised trials, Risk of bias: 2 trials low, 4 high
- Bayesian regression models
- Individually randomised and cluster-randomised trials
- Risk of bias: 2 trials low, 4 high
Pooled result
As reported in the abstract
Balanced solutions vs SalineOdds ratio (95% CrI)
CrI
0.962(0.909–1.019)
Balanced solutions vs SalineAbsolute difference, percentage points (95% CrI)
Balanced solutions
−0.4(−1.5 to 0.2)
- Posterior probability that balanced solutions reduced mortality
- 0.895
Further pooled results
| Outcome | Balanced solutions | Saline | OR (CrI) | |
|---|---|---|---|---|
| In-hospital mortality, TBI (prespecified subgroup) | 19.1% | 14.7% | 1.424 (1.100–1.818) | |
| 0.512Odds ratio (log scale) |
| Outcome | Absolute difference (percentage points) (CrI) | |
|---|---|---|
| In-hospital mortality, TBI (prespecified subgroup) | 3.2 (0.7–8.7) | |
| −50510Difference, percentage points (linear scale) |
- In-hospital mortality, TBI (prespecified subgroup) — Probability that balanced solutions increased mortality in TBI
- 0.975
Original publication
Balanced crystalloids versus saline for critically ill patients (BEST-Living): a systematic review and individual patient data meta-analysis. Lancet Respir Med. Published 30 November 2023. doi:10.
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