Balanced Crystalloids versus Saline in Noncritically Ill Adults

Area of Science:

• Emergency Medicine
• Nephrology
• Critical Care

Background:

• Uncertainty exists regarding the comparative clinical effects of balanced crystalloids versus saline, especially in non-critically ill patients outside the ICU.
• Intravenous fluid administration is common in emergency departments, necessitating clarity on optimal crystalloid choice.

Purpose of the Study:

• To compare the clinical outcomes of balanced crystalloids versus saline in non-critically ill adults receiving intravenous fluids in the emergency department.
• To assess the impact of fluid choice on hospital-free days and major adverse kidney events.

Main Methods:

• A single-center, pragmatic, multiple-crossover trial was conducted.
• Adult patients treated with intravenous crystalloids in the emergency department and hospitalized outside the ICU were randomized monthly to receive either balanced crystalloids (lactated Ringer's or Plasma-Lyte A) or saline.
• Primary outcome was hospital-free days; secondary outcome was major adverse kidney events within 30 days.

Main Results:

• A total of 13,347 patients were enrolled.
• No significant difference was observed in hospital-free days between the balanced crystalloids and saline groups (median, 25 days each).
• Balanced crystalloids showed a statistically significant lower incidence of major adverse kidney events within 30 days compared to saline (4.7% vs. 5.6%; P=0.01).

Conclusions:

• In non-critically ill adults treated in the emergency department, balanced crystalloids and saline yield similar hospital-free days.
• Balanced crystalloids may offer a benefit by reducing the incidence of major adverse kidney events compared to saline in this patient population.