Which intravenous fluid is better?

Balanced crystalloids or 0.9% Saline?

SMART Trial:

Pragmatic, cluster-randomized, multiple-crossover trial done in five ICUs at an academic center, 15,802 adults for saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) with 7942 patients in balanced group vs 7860 patients in saline group.

OUTCOME:

Major adverse kidney event – Balanced 14.3% vs saline 15.4%

Inhospital mortality at 30 days – Balanced 10.3% vs Saline 11.1%

Incidence of new renal replacement therapy- Balanced 2.5% vs Saline 2.9%

Incidence of persistant renal dysfunction – Balanced 6.4% vs Saline 6.6%

Click here to know more about the SMART Trial outcome…

SPLIT Trial:

A prospective, investigatorinitiated, multicenter, blinded, cluster-randomized, doublecrossover study conducted in 4 tertiary ICUs in New Zealand.

2278 patients- 1162 buffered crystalloids and 1116 saline groups.

Outcome:

AKI within 90 days of enrollment- Buffered crystalloids 9.6% vs Saline 9.2%

RRT requirement- Buffered 3.3% vs Saline 3.4%

Inhospital mortality- Buffered 7.6% vs saline 8.6%

Click here to know more about the SPLIT Trial outcome…

BASICS Trial:

A Double-blind, factorial, randomized clinical trial conducted at 75 ICUs in Brazil. 10520 patients eligible.

Outcome:

90 days mortality- Balanced solution 26.4% vs Saline 27.2%

Click here to know more about the BASICS Trial outcome…

PLUS Trial:

A double-blind, randomized, controlled trial done in Australia and New Zealand. 5037 patients from 53 ICUs – 2515 in balanced group and 2522 in saline group.

Outcome:

90 days mortality- Balanced 21.8% vs saline 22%

New RRT- Balanced 12.7% vs saline 12.9%

Will these findings change practice? When a patient is dying , does it matter which fluid are you using for resuscitation? Millions of litres of IV fluids are being used daily. I think may be we are the better judge here.

Click here to know more about the PLUS Trial outcome…

By Dr. Apurba Kumar Borah @ ccemjournal.com