{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T20:14:07Z","timestamp":1784837647937,"version":"3.55.0"},"reference-count":32,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Critical Care"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.jcrc.2026.155665","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:28:38Z","timestamp":1782512918000},"page":"155665","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Balanced crystalloids versus saline and mortality in hospitalized patients: a hierarchical Bayesian meta-analysis of cluster-randomized trials"],"prefix":"10.1016","volume":"95","author":[{"given":"Javier","family":"Ripoll\u00e9s-Melchor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel V.","family":"Espinosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manu L.N.G.","family":"Malbrain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan V.","family":"Lorente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Colomina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosal\u00eda","family":"Navarro-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"U\u00f1a-Orej\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ane","family":"Abad-Motos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Budithi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Yanes-Vidal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Abad-Gurumeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0005","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13613-018-0402-x","article-title":"Principles of fluid management and stewardship in septic shock: it is time to consider the four D\u2019s and the four phases of fluid therapy","volume":"8","author":"Malbrain","year":"2018","journal-title":"Ann Intensive Care"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0010","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1186\/s12871-021-01518-z","article-title":"Observational study on fluid therapy management in surgical adult patients","volume":"21","author":"Colomina","year":"2021","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0015","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s13613-021-00851-3","article-title":"Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults","volume":"11","author":"Van Regenmortel","year":"2021","journal-title":"Ann Intensive Care"},{"issue":"4","key":"10.1016\/j.jcrc.2026.155665_bb0020","first-page":"299","article-title":"The ideal crystalloid - what is \u2018balanced\u2019?","volume":"19","author":"Morgan","year":"2013","journal-title":"Curr Opin Crit Care"},{"issue":"9","key":"10.1016\/j.jcrc.2026.155665_bb0025","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1056\/NEJMoa2114464","article-title":"Balanced multielectrolyte solution versus saline in critically ill adults","volume":"386","author":"Finfer","year":"2022","journal-title":"N Engl J Med"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0030","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1186\/s13054-019-2658-4","article-title":"Why physiology will continue to guide the choice between balanced crystalloids and normal saline: a systematic review and meta-analysis","volume":"23","author":"Zwager","year":"2019","journal-title":"Crit Care"},{"issue":"9","key":"10.1016\/j.jcrc.2026.155665_bb0035","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1056\/NEJMoa1711584","article-title":"Balanced crystalloids versus saline in critically ill adults","volume":"378","author":"Semler","year":"2018","journal-title":"N Engl J Med"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0040","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1060028019866420","article-title":"Balanced crystalloids versus saline in critically ill adults: a systematic review and Meta-analysis","volume":"54","author":"Hammond","year":"2020","journal-title":"Ann Pharmacother"},{"issue":"3","key":"10.1016\/j.jcrc.2026.155665_bb0045","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S2213-2600(23)00417-4","article-title":"Balanced crystalloids versus saline for critically ill patients (BEST-living): a systematic review and individual patient data meta-analysis","volume":"12","author":"Zampieri","year":"2024","journal-title":"Lancet Respir Med"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0050","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13613-023-01177-y","article-title":"Multidisciplinary expert panel report on fluid stewardship: perspectives and practice","volume":"13","author":"Malbrain","year":"2023","journal-title":"Ann Intensive Care"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0055","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jclinepi.2008.07.006","article-title":"Bayesian statistical inference enhances the interpretation of contemporary randomized controlled trials","volume":"62","author":"Wijeysundera","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.jcrc.2026.155665_bb0060","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"10.1016\/j.jcrc.2026.155665_bb0065","author":"Ldridge"},{"issue":"9","key":"10.1016\/j.jcrc.2026.155665_bb0070","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: the RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am J Public Health"},{"key":"10.1016\/j.jcrc.2026.155665_bb0075","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h2147","article-title":"The PRECIS-2 tool: designing trials that are fit for purpose","volume":"350","author":"Loudon","year":"2015","journal-title":"BMJ"},{"key":"10.1016\/j.jcrc.2026.155665_bb0080","series-title":"GRADE handbook for grading quality of evidence and strength of recommendations","year":"2013"},{"key":"10.1016\/j.jcrc.2026.155665_bb0085","series-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2021"},{"issue":"1","key":"10.1016\/j.jcrc.2026.155665_bb0090","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v080.i01","article-title":"Brms: an R package for Bayesian multilevel models using Stan","volume":"80","author":"B\u00fcrkner","year":"2017","journal-title":"J Stat Softw"},{"issue":"3","key":"10.1016\/j.jcrc.2026.155665_bb0095","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J Stat Softw"},{"issue":"16","key":"10.1016\/j.jcrc.2026.155665_bb0100","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1001\/jama.2015.12334","article-title":"Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial","volume":"314","author":"Young","year":"2015","journal-title":"JAMA"},{"issue":"6","key":"10.1016\/j.jcrc.2026.155665_bb0105","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s00134-017-4772-6","article-title":"Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial","volume":"43","author":"McIlroy","year":"2017","journal-title":"Intensive Care Med"},{"issue":"9","key":"10.1016\/j.jcrc.2026.155665_bb0110","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1056\/NEJMoa1711586","article-title":"Balanced crystalloids versus saline in noncritically ill adults","volume":"378","author":"Self","year":"2018","journal-title":"N Engl J Med"},{"issue":"4","key":"10.1016\/j.jcrc.2026.155665_bb0115","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1097\/ALN.0000000000003130","article-title":"Saline versus lactated ringer\u2019s solution: the saline or lactated ringer\u2019s (SOLAR) trial","volume":"132","author":"Maheshwari","year":"2020","journal-title":"Anesthesiology"},{"issue":"5","key":"10.1016\/j.jcrc.2026.155665_bb0120","doi-asserted-by":"crossref","first-page":"e0251718","DOI":"10.1371\/journal.pone.0251718","article-title":"The effects of 0.9% saline versus plasma-Lyte 148 on renal function as assessed by creatinine concentration in patients undergoing major surgery: a single-Centre double-blinded cluster crossover trial","volume":"16","author":"Weinberg","year":"2021","journal-title":"PloS One"},{"key":"10.1016\/j.jcrc.2026.155665_bb0125","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1164\/rccm.202111-2484OC","article-title":"BaSICS investigators and the BRICNet. Association between type of fluid received prior to enrollment, type of admission, and effect of balanced crystalloid in critically ill adults: a secondary exploratory analysis of the BaSICS clinical trial","volume":"205","author":"Zampieri","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"10.1016\/j.jcrc.2026.155665_bb0130","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.chest.2020.08.2068","article-title":"Effect of early balanced crystalloids before ICU admission on Sepsis outcomes","volume":"159","author":"Jackson","year":"2021","journal-title":"Chest"},{"issue":"12","key":"10.1016\/j.jcrc.2026.155665_bb0135","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1164\/rccm.202203-0611ED","article-title":"Back to BaSICS: early treatments matter in critical illness","volume":"205","author":"Seitz","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"10.1016\/j.jcrc.2026.155665_bb0140","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100010","article-title":"Balanced crystalloids versus saline in critically ill adults - a systematic review with meta-analysis","volume":"1","author":"Hammond","year":"2022","journal-title":"NEJM Evid"},{"issue":"7","key":"10.1016\/j.jcrc.2026.155665_bb0145","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1056\/NEJMoa2416761","article-title":"A crossover trial of hospital-wide lactated ringer\u2019s solution versus Normal saline","volume":"393","author":"McIntyre","year":"2025","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jcrc.2026.155665_bb0150","doi-asserted-by":"crossref","first-page":"1367916","DOI":"10.3389\/fendo.2024.1367916","article-title":"Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials","volume":"15","author":"Liu","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"6","key":"10.1016\/j.jcrc.2026.155665_bb0155","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.bja.2024.08.008","article-title":"Comparative efficacy of balanced crystalloids versus 0.9% saline on delayed graft function and perioperative outcomes in kidney transplantation: a meta-analysis of randomised controlled trials","volume":"133","author":"Chang","year":"2024","journal-title":"Br J Anaesth"},{"issue":"8","key":"10.1016\/j.jcrc.2026.155665_bb0160","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1164\/rccm.201809-1677CI","article-title":"Balanced crystalloid solutions","volume":"199","author":"Semler","year":"2019","journal-title":"Am J Respir Crit Care Med"}],"container-title":["Journal of Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0883944126002431?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0883944126002431?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T19:46:05Z","timestamp":1784835965000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0883944126002431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":32,"alternative-id":["S0883944126002431"],"URL":"https:\/\/doi.org\/10.1016\/j.jcrc.2026.155665","relation":{},"ISSN":["0883-9441"],"issn-type":[{"value":"0883-9441","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Balanced crystalloids versus saline and mortality in hospitalized patients: a hierarchical Bayesian meta-analysis of cluster-randomized trials","name":"articletitle","label":"Article Title"},{"value":"Journal of Critical Care","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jcrc.2026.155665","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"155665"}}