February 28, 2018

Background:  Normal Saline (NS) is one of the most commonly used IVFs in resuscitation today.  The use of balanced vs unbalanced crystalloids has been one of the biggest debates in resuscitation of the critically ill in recent history due to concerns of unbalanced fluids causing acute kidney injury, hyperchloremic metabolic acidosis,  and worsened mortality.  In 2015, we saw the publication of the SPLIT trial, which we covered on REBEL EM. This was a randomized clinical trial of over 2200 patients in 4 ICUs in New Zealand comparing 0.9% Saline (NS) vs Plasma-Lyte.  This trial had many issues including, >70% of patients coming from the OR, only 15% came from the ED, only 4% had sepsis, and the biggest issue with this trial was that the majority of patients only received 1 – 2L of NS, making it unclear if larger volumes of unbalanced crystalloid would have worsened morbidity and mortality.  Since the publication of this study, two more trials have been published: The SALT-ED Trial and The SMART trial (Both Just published in the NEJM Feb 27th, 2018).