What type of fluid we use in critical care resuscitation has been hotly debated for some time
The most recent battles have been played out between NS and plasmalyte or buffered solutions
There has been some evidence that high chloride solutions can lead to renal injury requiring renal replacement therapy (RRT)
Does a buffered crystalloid reduce renal complications compared with normal saline in patients admitted to the ICU?
The SPLIT Trial (Saline vs Plasma-Lyte) from New Zealand ICU's adds more to our knowledge about this topic while enrolling over 2,000 patients
Summary:
Primary outcome was a rise in creatinine
There was no difference in the primary outcome or incidence of AKI
There was no difference in use of RRT or mortality
Suggesting that is doesnt make too much of a difference
There were some limitations: 90% of patients were given fluid before enrollment that was buffered crystalloid and patients were only given around 2 liters on average of fluid in the ICU
The Bottom Line: This was a nicely designed study to evaluate the safety of both fluids. It does suggest that either fluid type is for the most part OK. But in patients requiring hefty fluid boluses, we should be cautious in what type of fluid we choose.
