OBJECTIVES: Fluid therapy is one of the most frequently prescribed medications in hospitalized patients. Fluid maintenance and resuscitation is an important strategy during major surgeries. Acetate-buffered balanced crystalloid solutes may influence acid-base status, intracellular and extracellular water content, plasma electrolyte compositions. The main aim of study was to evaluate modern evidence of the efficacy and safety of acetate-buffered crystalloid solutions for fluid therapy during the abdominal surgery in adults.

METHODS: Medline, the Cochrane Library, eLIBRARY.ru were searched up to 31 May 2020 using the key words “acetate-buffered” AND “crystalloids”. Systematic review was conducted in accordance with PRISMA guidelines using specified PICO(S) criteria: population – adult patients undergoing major abdominal surgeries; intervention – acetate-buffered crystalloids; comparators - non-acetate-buffered crystalloids; outcomes – pH, serum sodium, chloride, bicarbonate and lactate levels, base excess, buffer bases, strong ion difference; study design. Studies published post-2009 in English and Russian were included.

RESULTS: Total of 53 studies were identified from all databases. Out of them 9 publications were selected for eligibility, of which 5 were included in the final review. One additional article was identified through citation reference lists. Acetate-buffered crystalloid solutes do have a favorable influence on microcirculation. Metabolic alkalosis did not occur in a single study after an acetate-buffered infusate; potassium levels stayed stable in all studies.

CONCLUSIONS: The number of studies targeting acetate-buffered crystalloid infusion fluids is low, and their patient collective is very diverse. Comparing to normal saline, balanced crystalloids are more beneficial in keeping postoperative electrolytes and acid-base balance among adult patients undergoing abdominal surgery. Whether acetate-buffered crystalloid fluids increased survival when compared with normal saline is yet unclear and may depend on the amount of fluid administered. Efficacy and safety of acetate-buffered crystalloid solutions for fluid therapy during the abdominal surgery in adults patients has been found to be convincing with the A evidence level.