Battle of the Crystalloids in the Operating Room: A Literature Review

Purpose: The purpose of this article is to synthesize the evidence regarding the commonalities and differences between the three most common crystalloid solutions used in the operating room (normal saline [NS], lactated Ringer's [LR], and Plasmalyte [PL]) in order to determine best practice.

Design: This study is an integrative review of literature.

Methods: A review of the literature was conducted using the PubMed, CINAHL Plus, and Cochrane Library databases. The inclusion criteria included adult patients undergoing surgery who received either NS, LR, and/or PL (or similar solutions) for fluid maintenance therapy.

Findings: A total of 15 articles from 2008 to 2020 conducted in a surgical setting were selected for the review; eleven randomized controlled studies, three observational studies, and one cohort-controlled trial.

Conclusions: The findings suggest balanced crystalloid solutions are superior to NS in the operating room in terms of maintaining a stable acid-base balance. PL is preferable to LR because it most closely resembles plasma concentration. Future research is needed to determine the cost-effectiveness of the solutions.