Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit

Abstract

clinicaltrials.gov Identifier: ACTRN12613001370796.

State of the art in fluid and volume therapy

“…There are also indications that balanced solutions are associated with advantages in terms of patient survival [32]. But in contrast, a recently published study found no survival benefit of balanced solution compared to saline solution [33]; however, the applied amount of infusion was so small in this study (<2 l applied slowly during the course of several days) that neither the chloride concentration nor the pH in the saline group could increase above or drop below the respective normal values. At ISICEM 2016, Kellum presented results from a very large cohort of patients demonstrating that larger amounts of saline solution were associated with increased mortality compared to balanced solutions.…”

It is time to consider the four D’s of fluid management

“…Normal saline, still one of the most employed intravenous crystalloid solutions, presents a non-physiologically high, content of Cl -(and Na + ), and has long been known to induce hyperchloremic metabolic acidosis. Despite the fact that some studies (mainly uncontrolled or retrospective) have shown that unbalanced solutions may not be as innocent as previously thought [3−5], only recently, the SPLIT trial has shed some new light on this issue [6]. This trial (the 0.9% Saline vs. Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy) is the first large randomized controlled trial comparing the clinical effects of two different types of crystalloids [6].…”

“…Despite the fact that some studies (mainly uncontrolled or retrospective) have shown that unbalanced solutions may not be as innocent as previously thought [3−5], only recently, the SPLIT trial has shed some new light on this issue [6]. This trial (the 0.9% Saline vs. Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy) is the first large randomized controlled trial comparing the clinical effects of two different types of crystalloids [6]. In this double-blind, cluster randomized, double-crossover trial, conducted in 4 ICUs in New Zealand, 2,278 ICU patients in need of crystalloid fluid therapy were enrolled to receive either 0.9% NaCl or Plasma-Lyte 148, as a balanced solution, according to an alternating block of 7-weeks for each specific ICU.…”

“…The United Kingdom's National Institute for Health and Care Excellence (NICE) recently provided a complete set of guidelines, algorithms and instructions for intravenous fluid therapy in adult hospitalised patients [7]. The somewhat older GIFTASUP-guidelines [8] summarize evidence specifically for the management of surgical patients.…”

“…Data on replacement fluids are sparse. Several recent guidelines advise one to match the amount of fluid and electrolytes as closely as possible to the fluid that is being or has been lost [7,8]. An overview of the composition of the different body fluids can be found in the NICE-guidelines [7].…”