This section mainly represents a place to store all those "balanced crystalloid vs saline" trials, which there would be no other place for. Otherwise, there are few critically important ICU-relevant trials, and surprisingly few widely accepted guidelines for fluid management, electrolyte replacement or investigations. Hyponatremia seems to be a notable outlier, but otherwise good luck finding a Consensus Statement from the International Committee for Electrolyte Correction in Critical Care, as there is no such body and there is no such statement.
Fluid and electrolyte trials
- SPLIT - 2015 - Plasma-Lyte vs saline in the ICU; n=2278 in NZ. No difference in rate of AKI (9.6% vs 9.2%) or hospital mortality (7.6% vs 8.6%).
- SALT-ED- 2018- Plasma-Lyte vs saline in the ward; n=13,347 in the US. No difference in hospital-free days, but much less composite renal badness (MAKE30 4.7% vs. 5.6%), especially in those with already crappy kidneys (creatinine > 133 mmol/L)
- SMART - 2018 - Plasma-Lyte vs saline in ICU; n=15,802 in the US. Composite renal badness better with balanced crystalloid (14.3% vs 15.4%, NNT=94)
- BaSICS (fluid type) - 2021 - Plasma-Lyte vs saline in ICU; n=11,052 in Brazil. No difference in mortality (26.4% vs 27.2%), except in TBI (31.3% vs 21.1% for the saline).
- PLUS - 2022 - Plasma-Lyte vs saline in ICU; n=5037 in Australia. No difference in mortality (21.8% v 22.0%) or risk of AKI (34.2% v 34.4%)
- BICAR-ICU - 2018 - isotonic (4.2%) bicarb for pH < 7.20. n=389, in France. No difference in composite outcome (71% vs 66%) except in AKI patients (82% vs 70%)
Fluid and electrolyte guidelines