Preferences and attitudes on acetate- versus lactate-buffered crystalloid solutions for intravenous fluid therapy—An international survey

Karen Louise Ellekjaer*, Praleene Sivapalan, Sheila N. Myatra, Lasse Grønningsæter, Johanna Hästbacka, Paul J. Young, Andrew J. Boyle, Marlies Ostermann, Carmen A. Pfortmueller, Ieva Jovaišienė, Jan De Waele, Annika Reintam Blaser, Abdulrahman Al-Fares, Ashish K. Khanna, Yaseen M. Arabi, Tomoko Fujii, Eric Keus, Mervyn Mer, Fayez Alshamsi, Maria CronhjortAnders Perner, Morten H. Møller, National and site investigators

*Corresponding author for this work

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Abstract

Background: Clinical practice guidelines recommend use of buffered crystalloid solutions in critically ill patients but do not distinguish between solutions based on different buffering anions, that is, acetate- versus lactate-buffered solutions. We therefore surveyed relevant physicians about their preferences and attitudes toward each solution. Methods: We conducted an international online survey of anesthesiologists (within perioperative care) and intensive care unit (ICU) physicians. The survey comprised 13 questions on respondents' attitudes and preferences regarding the use of acetate- and/or lactate-buffered crystalloid solutions, including their opinions on a potential clinical trial comparing these solutions and the clinical importance of such a trial. Results: A total of 1321 respondents participated, with a response rate of 34%, ranging from 14% to 96% across 18 countries. Most surveyed physicians reported using buffered crystalloid solutions “very often” (76%) or “often” (16%). Availability of acetate- and lactate-buffered solutions varied, as 35% of respondents reported having both types available, 35% reported having only acetate-, and 24% reported having only lactate-buffered solutions available. Most respondents (87%) would support a randomized trial in adult emergency surgical patients and ICU patients comparing an acetate- versus lactate-buffered crystalloid solution. The median rating of the clinical importance of this question was 5 (interquartile range 4–6) on a scale from 1 to 9. Conclusions: In this international survey, the reported use of buffered crystalloid solutions was high. Availability of the different solutions varied widely. The support for a potential randomized trial was high, with the clinical importance rated important but not critical by most respondents.

Original languageEnglish
Article numbere14553
JournalActa Anaesthesiologica Scandinavica
Volume69
Issue number1
Number of pages10
ISSN0001-5172
DOIs
Publication statusPublished - 2025

Bibliographical note

Publisher Copyright:
© 2024 Acta Anaesthesiologica Scandinavica Foundation.

Keywords

  • acetate
  • crystalloid
  • fluid therapy
  • intravenous fluid
  • lactate

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