In patients who need IV fluids, we can either provide “normal saline” or balanced salt solutions.
Balanced salt solutions include Lactated Ringer’s and Plasmalyte.
There have been several trials trying to answer this question.
The data hasn’t been as rock solid as we’d like to convince our biases.
The BaSICS trial is a recent landmark trial.
As always, I recommend you read this full free article for yourself and do not trust me. This is not medical advice. Hat tip to the authors.
They enrolled over 10,000 patients into this randomized clinical trial. This is impressive.
The primary outcome was 90-day mortality.
I’ll cut to the chase and say that there’s no difference.
They had a considerable number of secondary outcomes, tertiary outcomes and pre-planned subgroup analyses.
They were hard pressed to find any differences although sepsis patients only represented less than 20% of the patient population and the patient populations weren’t that sick.
But this isn’t the end of the story.
Some additional number crunching took place and they did find a benefit for balanced salt solutions on mortality if there was no mixing and matching of the fluids.
Stick with the balanced salt solutions and your patients will possibly do better.
Citations for the BaSICS Trial
Zampieri FG, Machado FR, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, Lovato WJ, Amêndola CP, Serpa-Neto A, Paranhos JLR, Guedes MAV, Lúcio EA, Oliveira-Júnior LC, Lisboa TC, Lacerda FH, Maia IS, Grion CMC, Assunção MSC, Manoel ALO, Silva-Junior JM, Duarte P, Soares RM, Miranda TA, de Lima LM, Gurgel RM, Paisani DM, Corrêa TD, Azevedo LCP, Kellum JA, Damiani LP, Brandão da Silva N, Cavalcanti AB; BaSICS investigators and the BRICNet members. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA. 2021 Aug 10;326(9):1–12. doi: 10.1001/jama.2021.11684. Epub ahead of print. PMID: 34375394; PMCID: PMC8356144.
Link to Article and FULL FREE PDF
Zampieri FG, Machado FR, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, Lovato WJ, Amêndola CP, Serpa-Neto A, Paranhos JLR, Lúcio EA, Oliveira-Júnior LC, Lisboa TC, Lacerda FH, Maia IS, Grion CMC, Assunção MSC, Manoel ALO, Corrêa TD, Guedes MAVA, Azevedo LCP, Miranda TA, Damiani LP, Brandão da Silva N, Cavalcanti AB. Association between Type of Fluid Received Prior to Enrollment, Type of Admission, and Effect of Balanced Crystalloid in Critically Ill Adults: A Secondary Exploratory Analysis of the BaSICS Clinical Trial. Am J Respir Crit Care Med. 2022 Jun 15;205(12):1419-1428. doi: 10.1164/rccm.202111-2484OC. PMID: 35349397.
Link to NOT FREE Article
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