Matthew W. Semler, MD, of Vanderbilt University Medica Center in Nashville, at the annual meeting of the Society of Critical Care Medicine (SCCM), presented new advances in trauma-therapy studies. He showed how hospitalized patients treated with IV balanced fluids, instead of saline, manifested a 1% decreased incidence of severe kidney injury and death.
Dr. Semler explained, according to MedPage Today, that even though the percentage revealed does not seem to represent a significant difference, the overall impact could mean a highly significant one.
The study, published by the New England Journal of Medicine, suggested that replacing saline with balanced fluids could eventually decrease mortality and morbidity rate in hospitals – among both critically ill and non-critically ill patients.
Avoiding dialysis and death
The concentration of chloride of saline is higher than the human plasma, while balanced fluids are essentially plasma electrolytes mixed with water. The group led by Dr. Semler gave, randomly, saline or balanced crystalloid solution (lactated Ringer’s solution or Plasma-Lyte A) to adults patients being treated in ICU’s at Vanderbilt University Medical Center.
The first evidence they found was significant adverse kidney event within 30 days – which meant a composite of death from any cause.
14.3% of the patients treated with balanced crystalloid solution experienced a major adverse kidney event, while the ones treated with saline intravenous fluids represented a 15.4% of the total population observed.
A similar situation was developed in the second trial, when 13,347 non-critically ill patients were involved as well. The experts used the balanced crystalloid solution and lowed the incidence of major adverse kidney events within 30 days, having a 4.7%, contrasting the 5.6% of the ones treated with saline fluids.
“We saw a consistent signal in the critically ill and non-critically ill patients,” Dr. Semler concluded.
Dr. Semler gave a concerning estimation of the statistics that make up the base of his study. He calculated that more than 5 million people in the U.S. are treated in ICU’s every year, and that approximately 50,000 to 75,000 people die.
The doctor thinks these deaths could be avoided by replacing saline with balanced fluids.
Changing random decisions
“There has not been evidence in favor of saline or balanced fluids. The choice about which one to use mostly comes down to how physicians are trained. Internal medicine physicians tend to use saline while anesthesiologists and surgeons tend to use balanced fluids more,” Dr. Semler said.
Timothy Burchman, MD of Emory Healthcare in Atlanta, stated that the findings reported by Dr. Semler should be seen as practice-changing. He explained that the saline solution was used, historically, because it was compatible with blood transfusions. However, the need for blood has been dramatically reduced in several hospital situations.
“After roughly 75 years of intravenous medicine and 50 years of advanced trauma life support, we are finally recognizing that maybe what we should be giving is what the patient has been losing,” Burchman declared.
The results of the study are currently representing the base for Vanderbilt hospitals to begin shifting to balanced fluids in the ICU and ward settings.
What about kids?
Erin Stenson, MD of Cincinnati Children’s Hospital, who is a pediatric critical care specialist, claimed that several clinicians at her institution began to use primary lactated Ringer’s treatment – based in part on findings she reported in her study presented at the SCCM.
Dr. Stenson showed how children with septic shock presented hyperchloremia – which is an electrolyte disturbance – when levels of chloride in blood are high. This eventually can lead to kidney dysfunction.
The doctor explained, considering they could only examine about 900 children, and could not know which type of IV solution these were being treated with, that it is incredible their team could develop the hypothesis that revealed saline IV use was significantly correlated with hyperchloremia.
“Since the use of normal saline is the most prevalent fluid that has been given at our institution, we presume that this [hyperchloremia] was due to the use of normal saline,” Dr. Stenson explained.
Source: New England Journal of Medicine