Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies


This systematic review attempts to examine current literature regarding the outcomes of septic patients who receive fluid resuscitation with balanced versus unbalanced crystalloids. Inclusion criteria were randomized controlled trials (RCTs), retrospective cohort studies, and clinical trials that presented either pediatric or adult patients who were admitted to the hospital in critically ill condition and received either 0.9% normal saline or any type of balanced crystalloid, with the presence of at least one out of three primary outcomes: comparative rates of mortality, renal dysfunction, or metabolic acidosis. Reports were excluded if they did not contain information regarding any primary outcome measure, had a mixed age population, or did not include septic patients. Pubmed was the database in which this systematic review was conducted, which took place from inception until July 2023. The included studies were summarized in the results section of this systematic review which includes the dates, patient population, interventions, primary outcomes, results, and overall conclusions of the authors. The total number of included studies was 11, with 107,921 total participants. 71,983 patients received normal saline, 17,846 received balanced crystalloids, and 7,054 received some combination of both. Results of the majority of studies point to balanced crystalloids as a better option for fluid resuscitation than normal saline, showing decreases in overall mortality as well as renal dysfunction and metabolic acidosis. The implications of this finding further support the weak recommendation made by the current Surviving Sepsis Campaign Guidelines, arguing for the preference of balanced over unbalanced crystalloids in initial management of sepsis.


SC 11.PAS.2023.Whittington.GR