The Great Fluid Debate

The last few years have seen an uptick in discussion around which fluid is best for resuscitation, balanced electrolytes or saline. In May, we reviewed a brand new paper that looked at difference in 90-day mortality and need for renal-replacement therapy between two treatment groups, one given Plasma Lyte 148 and the other 0.9% NaCl. The study was a randomized, double-blind trial that looked at multiple other factors, such as outcome for septic patients, age, and sex. The authors concluded that there was no difference in 90-day mortality, new renal-replacement therapy, or serum creatinine levels between the two groups; a conclusion that only stokes the fire of the fluid-choice controversy.

We would love to hear your thoughts on the benefits and harms of each type of resuscitation fluid. If you’re interested in some light reading, you can find our May slideshow on the “Past Meetings” page, and the links to a few landmark electrolyte vs saline studies, all of which are open access with a quick Google Scholar search of their DOIs.

•Finer et al. Balanced Multielectrolyte Solution Versus Saline in Critically Ill Adults. NJEM. 2022, 386(9), 815-826. DOI: 10.1056/NEJMoa2114464

•Semler et al. Balanced Crystalloids Versus Saline in Critically Ill Adults. NJEM. 2018, 378, 829-839. DOI: 10.1056/NEJMoa1711584

•Young et al. Effect of a Buffered Crystalloid Solution Versus Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial. JAMA. 2015, 314(16), 1701-1710. DOI: 10.1001/jama.2015.12334