Balanced Crystalloids versus Saline in Critically Ill Adults

Area of Science:

• Critical Care Medicine
• Nephrology
• Emergency Medicine

Background:

• Intravenous fluid administration is crucial for critically ill adults.
• Both balanced crystalloids and saline are commonly used, but their comparative clinical outcomes remain unclear.

Purpose of the Study:

• To compare the clinical outcomes of balanced crystalloids versus saline in critically ill adults.
• To determine which fluid type results in better major adverse kidney events.

Main Methods:

• A pragmatic, cluster-randomized, multiple-crossover trial involving 15,802 adults across five intensive care units.
• Patients were assigned to receive either saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's or Plasma-Lyte A).
• The primary outcome was a composite of major adverse kidney events within 30 days, including death, new renal-replacement therapy, or persistent renal dysfunction.

Main Results:

• Balanced crystalloids led to a lower incidence of major adverse kidney events (14.3%) compared to saline (15.4%) (odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04).
• In-hospital mortality was slightly lower in the balanced crystalloids group (10.3%) versus the saline group (11.1%) (P=0.06).
• Incidence of new renal-replacement therapy and persistent renal dysfunction were not significantly different between the groups.

Conclusions:

• Balanced crystalloids are associated with improved kidney outcomes in critically ill adults compared to saline.
• The use of balanced crystalloids resulted in a statistically significant reduction in major adverse kidney events.