Balanced Crystalloids versus Saline in Critically Ill Adults
By M. Semler, W. Self, Jonathan P. Wanderer, Jesse M. Ehrenfeld, Li Wang, Daniel W Byrne, J. Stollings, Avinash B. Kumar, Christopher G Hughes, Antonio Hernandez and 8 more. Journal Club AINS, 2018
1,137 citations recorded by the source corpus.
BACKGROUND Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. METHODS In a pragmatic, cluster‐randomized, multiple‐crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma‐Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days — a composite of death from any cause, new renal‐replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) — all censored at hospital discharge or 30 days, whichever occurred first. RESULTS Among the 7942 patients in the balanced‐crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04). In‐hospital mortality at 30 days was 10.3% in the balanced‐crystalloids group and 11.1% in the saline group (P=0.06). The incidence of new renal‐replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P=0.60). CONCLUSIONS Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal‐replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART‐MED and SMART‐SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779.)
Subfields: Critical Care and Intensive Care Medicine, Nephrology
View Paper: https://www.semanticscholar.org/paper/550c6b6d37e9aed5646faede9465fc26f86b8c89
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Citations in the corpus
- Sepsis and septic shock. (2018, background): “58 Notably, in another study by the same group of investigators, no difference in outcomes was observed when balanced solutions and normal saline were com pared in non-critically ill patients.”
- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition (2019, background): “In the other study, critically ill patients receiving balanced crystalloid solutions compared with saline were shown to have a lower rate of composite outcome death from any cause, new renal replacement therapy or persistent renal dysfunction [343].”