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Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

Simon Finfer1, Sharon Micallef1, Naomi Hammond1

  • 1From the George Institute for Global Health and the University of New South Wales (S.F., S.M., N.H., L.B., A.D., M.G., Q.L., J. Mysore, M.S., C.T., J. Myburgh), the Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital (N.H., A.D.), the Northern Clinical School (A.D.) and the Central Clinical School (D.G.), University of Sydney, the Intensive Care Unit, Royal Prince Alfred Hospital (D.G.), the Department of Intensive Care, St. George Hospital (M.S., J. Myburgh), and the Intensive Care Unit, Bankstown Hospital (M.S.), Sydney, and the Intensive Care Unit, Austin Hospital (R.B.), the Department of Intensive Care, Royal Melbourne Hospital (R.B.), the Department of Critical Care, University of Melbourne (R.B., P.Y.), and the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (R.B., P.Y.), Melbourne, VIC - all in Australia; the School of Public Health, Imperial College London, London (S.F.); and the Medical Research Institute of New Zealand (L.N., D.M., P.Y.) and the Department of Intensive Care, Wellington Regional Hospital (L.N., P.Y.) - both in Wellington.

The New England Journal of Medicine
|January 18, 2022
PubMed
Summary

Balanced multielectrolyte solution (BMES) did not reduce the risk of death or acute kidney injury in critically ill patients compared to saline. This large randomized trial found no significant difference in mortality or renal outcomes between the fluid therapies.

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Clinical Trials

Background:

  • The comparative effectiveness of balanced multielectrolyte solutions (BMES) versus 0.9% sodium chloride (saline) for fluid therapy in critically ill patients remains uncertain regarding acute kidney injury (AKI) and mortality risks.
  • This study addresses the uncertainty surrounding fluid choice in intensive care units (ICUs).

Purpose of the Study:

  • To determine if balanced multielectrolyte solution (BMES), when used instead of saline, reduces the risk of death or acute kidney injury in critically ill patients.
  • To compare the primary outcome of 90-day mortality and secondary outcomes of renal-replacement therapy and creatinine increase between BMES and saline groups.

Main Methods:

  • A double-blind, randomized, controlled trial involving 5037 critically ill patients across 53 ICUs in Australia and New Zealand.
  • Patients were assigned to receive either BMES (Plasma-Lyte 148) or saline for fluid therapy over 90 days.
  • Primary outcome was all-cause death within 90 days; secondary outcomes included new renal-replacement therapy and maximum creatinine increase during ICU stay.

Main Results:

  • No significant difference in 90-day mortality was observed between the BMES group (21.8%) and the saline group (22.0%) (difference -0.15%, P=0.90).
  • Rates of new renal-replacement therapy (12.7% vs 12.9%) and mean maximum increase in serum creatinine (0.41 mg/dL vs 0.41 mg/dL) were similar between groups.
  • Adverse and serious adverse events did not differ meaningfully between the BMES and saline treatment arms.

Conclusions:

  • The study found no evidence that BMES offers a reduced risk of death or acute kidney injury compared to saline in critically ill adults.
  • Fluid choice between BMES and saline does not appear to impact major clinical outcomes like mortality or the need for renal replacement therapy in the ICU setting.