Glucose monohydrate 20g / Sodium chloride 3.5g / Sodium bicarbonate 2.5g oral powder sachets

BackgroundEx vivo lung perfusion (EVLP) supports assessment and rehabilitation of donor lungs. It runs as a closed circuit, so electrolytes and metabolites accumulate over the duration of perfusion. This systematic review investigates the impact of various dialysis or perfusate exchange (PE) techniques on electrolyte balance, inflammation and lung function during EVLP.MethodsA literature search of PubMed and Embase was conducted from database inception to September 17, 2025. We included all articles describing human or animal studies that tested dialysis or PE during EVLP. Outcomes included electrolytes, lactate, pH, edema formation, lung performance characteristics, and inflammatory markers.ResultsFive studies met the inclusion criteria, one human and four porcine models, with a total of 57 subjects. Across studies, dialysis consistently improved solute clearance, lowering sodium, potassium, and chloride, while increasing calcium and glucose, reducing lactate accumulation, and maintaining physiologic pH. PE did not sustain physiologic pH and had limited impact on electrolyte homeostasis, with only transient effects on lactate. No differences were observed in lung function parameters including oxygenation, compliance, and airway pressure. Pro-inflammatory cytokine production was largely unchanged, however, interleukin (IL)-10 was elevated with dialysis in several studies.ConclusionDuring EVLP, dialysis stabilized acid-base status and metabolites. These biochemical gains did not translate into consistent improvements in oxygenation or compliance. Smaller dialysis membranes were associated with higher pulmonary artery pressure (PAP) and increased cytokine profile. Future studies should extend EVLP duration with perfusate clearance to evaluate whether perfusate clearance strategies provide additional benefits with longer duration preservation.

Abstract licence: CC BY-NC-ND

AimsIntravenous (i.v.) hypertonic saline alongside i.v. loop diuretics is sometimes used to enhance diuresis in people hospitalized with heart failure (HF) but is challenging to administer. Oral sodium chloride (NaCl) supplements might be a practical alternative, but little is known about their effects in patients with HF. We performed a rapid review of the relevant evidence.Methods and resultsA rapid systematic review was registered (PROSPERO: CRD420250618965) and reported following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Medline and Cochrane Central Register of Controlled Trials databases were searched for studies involving adults with HF administered with oral NaCl. Randomized and observational studies were included. Studies of oral NaCl restriction or i.v. hypertonic NaCl were excluded. All available data were extracted. Risk of bias was evaluated using Risk of Bias 2 and Risk Of Bias In Nonrandomized Studies of Interventions tools. From an initial 335 records, five studies involving 139 patients were included. Oral NaCl did not affect weight or urine volume but were associated with higher serum and urinary sodium concentrations. Some studies reported that NaCl was associated with smaller diuretic-induced increases in serum urea and creatinine, lower haematocrit, higher plasma volume, and less neurohormonal activation compared to normal NaCl intake. Clinical outcomes, including hospital length of stay and mortality, were unaffected. The quality of evidence was limited by small sample sizes and methodological heterogeneity.ConclusionFor patients with HF treated with loop diuretics, higher oral NaCl intake may increase serum and urine sodium concentration, improve renal function, and reduce neurohormonal activation. There is insufficient evidence to support oral NaCl as an adjunct to diuretic treatment. More research is needed.

Abstract licence: CC BY

ObjectiveThe choice of crystalloid solution considerably affects perioperative outcomes in neurosurgery. This study aimed to evaluate the effects of Plasma-Lyte 148 and 0.9% saline on acid-base and hydroelectrolyte balance in adults undergoing elective neurosurgical procedures.MethodsA double-blind randomized controlled trial was conducted at Botucatu Medical School from November 2019 to May 2020. Patients received either Plasma-Lyte 148 or 0.9% saline at a maintenance rate of 2mL/kg/h, with additional bolus guided by mean arterial pressure and pulse pressure variation. The primary endpoint was arterial pH at the end of surgery.ResultsSixty-eight patients (33 in the Plasma-Lyte 148 group and 35 in the saline group) completed the study. The total median volumes administered (1st-3rd quartiles) were 2,227 (1,416-3,000) and 3,000 (2,000-4,000) mL in the Plasma-Lyte 148 and saline groups, respectively (p=0.107). At procedure completion, Plasma-Lyte 148 demonstrated superior acid-base homeostasis with significantly higher pH (7.39±0.04 versus 7.35±0.05, pConclusionPlasma-Lyte 148 provides superior acid-base homeostasis compared to 0.9% saline in patients undergoing neurosurgery, with significantly better pH, bicarbonate, and base excess profiles while avoiding hyperchloremia. These findings support the preferential use of balanced crystalloids in neurosurgical practice, aligning with current evidence favoring Plasma-Lyte 148 for optimal perioperative fluid management. ReBEC platform registration number: RBR-2592-hd.

Abstract licence: CC BY