balanced crystalloids have no mortality benefit compared to normal saline

  • Meta analysis in 2019 found no difference between LR and NS. 1
  • SMART: A pragmatic study involving 15,000 patients at Vanderbilt found for sepsis, LR has much lower mortality (0.74, 95% CI 0.59-0.93), AKI, ventilator free days, RRT free days compared to NS. 2 3
  • Most recent Basics trial found no difference between LR and NS. 4

  • no overall difference but trend towards balanced crystalloids
  • except TBI patients (maybe cerebral edema gets worse with free water with balanced crystalloid)

Footnotes

  1. Liu C, Lu G, Wang D, et al. Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: A systematic review and meta-analysis with trial sequential analysis. Am J Emerg Med. 2019;37(11):2072-2078. doi:10.1016/j.ajem.2019.02.045 ↩

  2. Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584 ↩

  3. Brown RM, Wang L, Coston TD, et al. Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical Trial. Am J Respir Crit Care Med. 2019;200(12):1487-1495. doi:10.1164/rccm.201903-0557OC ↩

  4. https://first10em.com/the-basics-trial-normal-saline-has-been-fine-all-along/ ↩