UMEM Educational Pearls

Category: Critical Care

Title: Balanced fluids in Critical Care

Keywords: plasmalyte, normal saline, fluid, critical care, fluid resuscitation (PubMed Search)

Posted: 12/8/2015 by Feras Khan, MD
Click here to contact Feras Khan, MD

  • 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:
  1. Primary outcome was a rise in creatinine
  2. There was no difference in the primary outcome or incidence of AKI
  3. There was no difference in use of RRT or mortality
  4. 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.


The SPLIT Randomized Clinical Trial

Paul Young et al.
JAMA. 2015;314(16):1701-1710. doi:10.1001/jama.2015.12334.