• Karen Louise Ellekjaer, Praleene Sivapalan, Sheila N Myatra, Lasse Grønningsæter, Johanna Hästbacka, Paul J Young, Andrew J Boyle, Marlies Ostermann, Carmen A Pfortmueller, Ieva Jovaišienė, Jan De Waele, Reintam BlaserAnnikaADepartment of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.Department of Intensive Care, Cantonal Hospital of Lucerne, Lucerne, Switzerland., Abdulrahman Al-Fares, Ashish K Khanna, Yaseen M Arabi, Tomoko Fujii, Eric Keus, Mervyn Mer, Fayez Alshamsi, Maria Cronhjort, Anders Perner, and Morten H Møller.
• Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
• Acta Anaesthesiol Scand. 2025 Jan 1; 69 (1): e14553e14553.

BackgroundClinical practice guidelines recommend use of buffered crystalloid solutions in critically ill patients but do not distinguish between solutions based on different buffering anions, that is, acetate- versus lactate-buffered solutions. We therefore surveyed relevant physicians about their preferences and attitudes toward each solution.MethodsWe conducted an international online survey of anesthesiologists (within perioperative care) and intensive care unit (ICU) physicians. The survey comprised 13 questions on respondents' attitudes and preferences regarding the use of acetate- and/or lactate-buffered crystalloid solutions, including their opinions on a potential clinical trial comparing these solutions and the clinical importance of such a trial.ResultsA total of 1321 respondents participated, with a response rate of 34%, ranging from 14% to 96% across 18 countries. Most surveyed physicians reported using buffered crystalloid solutions "very often" (76%) or "often" (16%). Availability of acetate- and lactate-buffered solutions varied, as 35% of respondents reported having both types available, 35% reported having only acetate-, and 24% reported having only lactate-buffered solutions available. Most respondents (87%) would support a randomized trial in adult emergency surgical patients and ICU patients comparing an acetate- versus lactate-buffered crystalloid solution. The median rating of the clinical importance of this question was 5 (interquartile range 4-6) on a scale from 1 to 9.ConclusionsIn this international survey, the reported use of buffered crystalloid solutions was high. Availability of the different solutions varied widely. The support for a potential randomized trial was high, with the clinical importance rated important but not critical by most respondents.© 2024 Acta Anaesthesiologica Scandinavica Foundation.

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