Xue M, et al. - Researchers analyzed randomized trials identified from electronic databases, reporting the use of balanced crystalloids vs 0.9% saline solutions in critically ill adult patients, to ultimately determine how clinical outcomes were influenced by the chloride content of intravenous crystalloid solutions in this patient population. The mortality, renal outcomes, serum content alterations and organ function were taken into account as outcome variables. They performed subgroup analysis by patient settings, types or volume of crystalloid fluid, or among sepsis vs non-sepsis, traumatic brain injury (TBI) vs non-TBI or subpopulations by the categories of baseline kidney function. For the assessment of random errors, they performed trial sequential analysis. The analysis included an overall 8 studies with 19,301 patients. Use of balanced crystalloid solutions offered a statistical survival benefit, as supported by limited evidence. These appeared beneficial in attenuating organ support duration and fluctuations in serum electrolyte and base excess. Furthermore, in subpopulation with sepsis and non-TBI, decreased in-hospital mortality was observed in relation to the use of balanced crystalloid solutions.