{
  "abstract": "Introduction: Bicarbonate-buffered crystalloids avoid exogenous lactate and have physicochemical properties distinct from compound sodium lactate (CSL), but direct comparative evidence during major abdominal surgery remains limited. Methods: This single-center, open-label, randomized non-inferiority trial enrolled high-risk adults undergoing elective major abdominal surgery. Participants received bicarbonate-buffered solution or CSL as the allocated intraoperative crystalloid. The primary estimand was the arithmetic mean difference in standard base excess (SBE) at skin closure (bicarbonate-buffered solution minus CSL). The non-inferiority margin was −1.5 mEq/L. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001228178). Results: Fifty participants were randomized (25 per group) and received their allocated intervention. End-of-surgery arterial blood gas data were missing for two CSL participants. In the intention-to-treat analysis using multiple imputation, the estimated mean difference in end-of-surgery SBE was −0.42 mEq/L (95% confidence interval [CI], −1.92 to 1.09 mEq/L). The complete-case per-protocol estimate was −0.48 mEq/L (95% CI, −2.02 to 1.06 mEq/L). In both analyses, the lower CI bound was below the prespecified non-inferiority margin; non-inferiority was not established. Secondary outcomes were exploratory; observed end-of-surgery lactate was lower with bicarbonate-buffered solution (median 0.9 vs 1.2 mmol/L; unadjusted P = 0.031), without a corresponding difference in SBE or pH. Conclusions: In this small trial of hemodynamically stable adults undergoing elective major abdominal surgery, the primary non-inferiority result was inconclusive. The data did not establish interchangeability, equivalence, superiority, or inferiority of the two fluids. As the trial was powered for a physiologic endpoint, no comparative inference can be made about organ dysfunction, postoperative complications, recovery, or mortality. Larger trials with standardized co-interventions and patient-important outcomes are required before routine substitution for CSL can be recommended.",
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  "affiliations": [
    "Department of Intensive Care, Austin Health, Melbourne, Australia",
    "Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia",
    "Department of Anaesthesia, Austin Health, Melbourne, Australia",
    "Department of Critical Care, The University of Melbourne, Melbourne, Australia",
    "Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea"
  ],
  "article_type": "Research Article",
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  "author_total": 13,
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      "name": "Fumitaka Yanase"
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      "name": "Laurence Weinberg"
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      "name": "Varun Peri"
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      "name": "Je Min Suh"
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      "name": "Rebecca Caragata"
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    {
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    {
      "name": "Michael Jiang"
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    {
      "name": "Qui Rui Soh"
    },
    {
      "name": "Shervin Tosif"
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    {
      "name": "Glenn Eastwood"
    },
    {
      "name": "Rinaldo Bellomo"
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    {
      "name": "Dong Kyu Lee"
    }
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  "bibtex": "https://research.draconitic.com/paper/4e1f2d5e6wdjv.bib",
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  "doi": "10.1371/journal.pone.0356619",
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  "licence_label": "CC BY 4.0",
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  "pmcid": null,
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  "published": "2026-09-09",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/4e1f2d5e6wdjv.ris",
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  "title": "Physicochemical effects of bicarbonate-buffered solution versus compound sodium lactate during major abdominal surgery: A randomized, open-label, non-inferiority trial",
  "title_text": "Physicochemical effects of bicarbonate-buffered solution versus compound sodium lactate during major abdominal surgery: A randomized, open-label, non-inferiority trial",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
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