PulmCrit (EmCrit)
PulmCrit - February 27, 2018 - By Josh Farkas
- “Normal” saline is a hypertonic, acidotic fluid. There is no physiologic rationale for its use as a resuscitative fluid.
- There are many potential problems related to saline. These include causing hyperchloremic acidosis, hyperkalemia, hemodynamic instability, renal malperfusion, systemic inflammation, and hypotension.
- Numerous small RCTs have emerged over the past few years which highlight various problems with saline resuscitation.
- The SMART and SALT-ED trials are massive, multiple-crossover trials which compare saline versus balanced crystalloids among critically ill and non-critical patients. Both studies found a 1% increase in death or renal failure with the use of saline.
- The combination of physiology, animal studies, numerous RCTs, SMART, and SALT-ED indicate that it's time to stop resuscitating with saline."