Fluids

Question 1

SALT-ED (2018)

Answer 1

Among non-critically ill patients in the ER requiring IVF, balanced crystalloid IV solutions (primarily Ringers Lactate) dose not reduce hospital free days but may have some impact in reducing major adverse kidney events compared to normal saline. NON ICU patients.

Question 2

SMART (2018)

Answer 2

Among critically ill patients, balanced crystalloid IV solutions ( Ringers Lactate or Plasma Lyte) reduces major adverse kidney events (composite of death, renal replacement therapy or doubling of baseline serum creatinine) compared to saline. Cumulative median volume was 1L for ICU admission.

Question 3

SPLIT (2015)

Answer 3

Among very heterogeneous ICU patient population, the incidence of acute kidney injury was not different between relatively small crystalloid volumes of plasma-lyte compared to normal saline.

Question 4

SAFE (2004)

Answer 4

For all ICU patients requiring fluid resuscitation albumin was equivalent to normal saline in 28 day mortality. Hypothesis-generating subgroup analysis indicated that trauma patients may benefit from normal saline whereas septic shock patients may benefit from albumin. This study is commonly cited as support that 500mL albumin is roughly equivalent in resuscitation to 1000mL of normal saline

Question 5

CRISTAL (2013)

Answer 5

In a heterogeneous ICU population with hypovolemia, there was no difference in 28-day mortality between crystalloids and colloids. Colloids did demonstrate benefit in a duration of mechanical ventilation, vasopressor use and 90 day mortality, although these were secondary endpoints that are conflicting with previous literature and deserve further study.