Thursday, April 25, 2019

Balanced crystalloids vs NS

R.E.B.E.L.EM - By Salim Rezaie - April 25, 2019
..."Meta-analysis of randomized controlled trials comparing balanced crystalloids vs NS in critically ill patients...
Author Conclusion: “Among critically ill patients receiving crystalloid fluid therapy, use of a balanced crystalloid compared with normal saline did not reduce the mortality, risk of severe AKI, or RRT use rate. Further large randomized clinical trials are needed to confirm or refute this finding.”
Clinical Take Home Point: This meta-analysis contributes very little to the current discussion mainly because of the heterogeneity of included studies. The use of fluid type in different pathologies isn’t really what we need, but rather tailored use of fluids with patient-oriented outcomes. It appears the debate over balanced crystalloids and normal saline in the resuscitation of the critically ill will continue. Although it makes more physiological sense to use balanced crystalloids in large volume (>2L) resuscitation, at this point in time it appears if you are using NS or a balanced crystalloid as your resuscitation fluid of choice keep using your fluid of choice, and don’t worry about changing your practice, although some individual studies have shown advantages in some clinical situations, until more robust evidence pushes you to do so."