Podcast 754: Balanced Fluids vs. Normal Saline, The Battle Continues

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Normal saline is thought to interfere with renal function and cause an acidosis and balanced fluids (like lactated ringers) are a better option</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The SALT-ED trial and SMART trial showed a small benefit with renal injury and need for dialysis using balanced fluid in critically ill patients</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Recent multicenter RCT in Brazil evaluated balanced fluids versus normal saline and looked at 90-day mortality</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Found no difference in 90-day mortality or secondary outcomes like renal function</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">PLUS trial is currently being done in Australia and New Zealand to further evaluate fluid choice</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Larger trials don’t show a major difference at this point, keep an eye out for future trials</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Semler MW, Wanderer JP, Ehrenfeld JM, et al. Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial. Am J Respir Crit Care Med. 2017;195(10):1362-1372. doi:10.1164/rccm.201607-1345OC</span></p> <p> </p> <p><span style="font-weight: 400;">Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584</span></p> <p><span style="font-weight: 400;">Zampieri FG, Machado FR, Biondi RS, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The