Written by Megan Hilbert
Spoon Feed
In the resuscitation of critically ill patients, the type of balanced crystalloid solution does not seem to affect clinical outcomes.
The selection of solution is fluid at best
While the literature has demonstrated improved outcomes for critically ill patients resuscitated with balanced crystalloid solution compared to normal saline, studies have yet to evaluate which balanced crystalloid solution is best.
This was a pragmatic, unblinded, single center, cluster-randomized, multiple-crossover trial that compared outcomes of ICU patients depending upon which balanced crystalloid solution they received: buffered with acetate and gluconate (Normosol-R) versus lactate (Lactated Ringers). These two solutions have a strong anion difference based upon their electrolyte composition (50mmol/L Normosol-R versus 28mmol/L Lactated Ringers). There were laboratory and clinical outcomes (i.e. bicarbonate and base excess; 30-day mortality and new kidney-replacement therapy). Ultimately, there were no clinically or statistically significant differences between the outcomes depending upon which fluid the patient was given.
*There is a lot of well done statistical analysis and discussion of results further in the article itself and I highly recommend you give it a read.*
How does this change my practice?
In my ER, I don’t have easy access to multiple kinds of balanced crystalloid solutions. Those who do should feel confident that, as long as you are picking a balanced crystalloid solution, you are doing your best by your critically ill patient.
Editor’s note: See the caveat about balanced fluid and worse outcomes in TBI patients we covered recently. ~Clay Smith
Source
Normosol-R vs Lactated Ringers in the Critically Ill: A Randomized Trial. Chest. 2025 Feb 17:S0012-3692(25)00165-5. doi: 10.1016/j.chest.2025.02.008. Epub ahead of print. PMID: 39971001
