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Normosol-R vs Lactated Ringers in the Critically Ill: A Randomized Trial.
Edward T Qian1, Ryan M Brown2, Karen E Jackson3
1Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
For critically ill adults, choosing between Normosol-R and lactated Ringer's IV fluids did not significantly impact acid-base status or clinical outcomes. This study found no difference in bicarbonate levels, kidney replacement therapy, or 30-day mortality between the two solutions.
Area of Science:
- Critical Care Medicine
- Fluid Resuscitation
- Electrolyte Balance
Background:
- Balanced crystalloid solutions are increasingly used for critically ill patients, potentially offering advantages over saline.
- However, limited data exist on whether specific balanced crystalloid compositions, such as Normosol-R versus lactated Ringer's, influence patient outcomes.
- Understanding these differences is crucial for optimizing fluid management strategies.
Purpose of the Study:
- To compare the impact of Normosol-R versus lactated Ringer's on acid-base status in critically ill adults.
- To evaluate the effect of these fluid choices on organ function, specifically kidney replacement therapy needs.
- To assess the influence of Normosol-R versus lactated Ringer's on 30-day mortality in critically ill patients.
Main Methods:
- A pragmatic, cluster-randomized, multiple-crossover trial was conducted at a US academic medical center.
- The study enrolled 2,084 critically ill adults, comparing intravenous fluid administration of Normosol-R against lactated Ringer's.
- Primary outcome was plasma bicarbonate concentration; secondary outcomes included kidney replacement therapy and 30-day mortality.
Main Results:
- No significant difference was observed in plasma bicarbonate concentrations between the Normosol-R and lactated Ringer's groups (mean difference, -0.12 mmol/dL; P = .61).
- Rates of new kidney replacement therapy were similar: 6.0% in the Normosol-R group versus 5.0% in the lactated Ringer's group.
- Thirty-day mortality also showed no significant difference, with 16.3% in the Normosol-R group and 16.0% in the lactated Ringer's group.
Conclusions:
- The choice between Normosol-R and lactated Ringer's for intravenous fluid therapy in critically ill adults did not significantly alter plasma bicarbonate levels.
- Clinical outcomes, including the need for kidney replacement therapy and 30-day mortality, were comparable between the two fluid resuscitation strategies.
- These findings suggest that, in this patient population, the specific composition of balanced crystalloid may not be a critical determinant of short-term outcomes.
