tailieunhanh - Báo cáo y học: ": Isotonic saline – the only solution to recommend"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Isotonic saline – the only solution to recommend? | Oremus Critical Care 2011 15 404 http content 15 1 404 CRITICAL CARE LETTER L_ Isotonic saline - the only solution to recommend Kresimir Oremus See related viewpoint by Guidet etal. http content 14 5 325 I read with interest the viewpoint by Guidet and colleagues addressing controversies regarding colloid solution carrier fluids 1 . Instead of offering a balanced view however the article focused on the refutation of dilutional hyper-chloraemic acidosis depicting it as a clinically innocent inevitability we should accept rather than try to avoid. The authors initially forward the view that unless recommendations are based on high quality primary research . clinicians would be better off making clinical decisions on the basis of primary data - just to end doing the opposite by recommending against the use of balanced colloid solutions based on limited published information 1 . To the best of my knowledge there are no published data suggesting adverse effects of balanced solutions compared with isotonic saline yet there remains the non issue of hyperchloraemic acidosis. Sound judgement suggests that if a clinical uncertainty can be avoided without suggestion of doing harm then a clinician may expect to be allowed the freedom of making such a choice. The conclusion this review should have is the one it begins with - the informed clinician should be left to make the decision in which patients to use a balanced colloid and in which to use an isotonic saline-based solution until evidence for clear benefit or harm can be demonstrated as recently suggested by one of the authors herself 2 . Since no data suggestive of balanced colloid being inferior to saline-based solutions are presented it seems unusual to forward opinions dismissive of existing noninferiority evidence since non-inferiority trials have become the mainstay for introducing new drugs 3 . Authors response Bertrand Guidet We believe we provided strong evidence demonstrating that .