lactated ringer maybe not better than normal saline

  • Meta analysis in 2019 found no mortality between crystalloid and colloid.1
  • Early meta analysis in 2019 found no difference between LR and NS. 2
  • 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. 3 4
  • Most recent Basics trial found no difference between LR and NS. 5

Footnotes

  1. Martin GS, Bassett P. Crystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: A systematic review and meta-analysis. J Crit Care. 2019;50:144-154. doi:10.1016/j.jcrc.2018.11.031 ↩

  2. 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 ↩

  3. 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 ↩

  4. 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 ↩

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