Balanced Crystalloid Fluids Shown Safer than Saline

Emergency intravenous (IV) administration of balanced crystalloids reduces mortality and complications compared to saline, according to a new study.

Researchers at Vanderbilt University Medical Center (VUMC, Nashville, TN, USA) conducted two pragmatic, multiple-crossover trials to compare the effect of balanced crystalloids (Lactated Ringer’s or Plasma-Lyte A) in 29,149 adults treated in the emergency department (ED) and hospitalized outside an intensive care unit (ICU). IV fluid type was assigned on calendar month basis, with crossover between balanced crystalloids and saline each month during the 16-month trial. Main outcomes included hospital-free days and 30-day major adverse kidney events (MAKE30).

The results showed that the median fluid volume in the ED was 1.1 liters, and 88% of the patients exclusively receiving the assigned fluid. Compared with saline, treatment with balanced crystalloids resulted in similar hospital free days, but a lower incidence of MAKE30 (4.7% versus 5.6%), which was manifest in reduced composite of death, new renal replacement therapy, and persistent renal dysfunction. The study was presented at the annual meeting of the American College of Chest Physicians (CHEST), held during October 2017 in Toronto (Canada).

“These fluids are used every day and in millions of patients annually in the United States and worldwide. There is no functional cost difference between them, and now we have the data to show that [balanced crystalloid fluids] produce a better patient outcome,” said lead author pulmonologist Matthew Semler, MD. “It’s reasonable to consider changing practice; we’ve changed our practice, and are transitioning from primarily using saline to primarily balanced crystalloid.”

Ringer's lactate, also known as Hartmann's solution, is a crystalloid mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure and for fluid resuscitation after blood loss due to trauma, surgery, or a burn injury.

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