Hypertonic solutions versus balanced crystalloids in severely burned patients: A systematic review and meta-analysis

To compare the effectiveness of hypertonic solutions versus balanced crystalloids on mortality in severely burned patients. A systematic review was performed, following the PRISMA guidelines and the recommendations of the Cochrane Collaboration. We searched Medline, EMBASE, CENTRAL, and LILACS for studies comparing hypertonic solutions (HTS) and balanced crystalloids (BCS) for resuscitation in burn patients. Outcomes included mortality, urine output, and total fluid volume infused at 24 h. The review and analysis included six studies. Meta-analysis showed a significant disadvantage in survival for HTS versus BCS (OR for survival 0.42, 95 % CI 0.25–0.70, I 2 : 0 %), equating to a higher mortality risk with HTS. This finding persisted even though HTS reduced fluid requirements in patients with major burns (>30 % TBSA). This meta-analysis suggests that the use of hypertonic solutions for resuscitation of severely burned patients is associated with a significantly higher risk of mortality compared to balanced crystalloids. This strong signal advocates a cautious clinical approach, favoring balanced crystalloids for resuscitation. However, more methodologically robust studies are needed to establish causality.