Balanced crystalloids versus saline for critically ill patients (BEST-Living): a systematic review and individual patient data meta-analysis
Analysis (6 RCTs;n=34,685) found use of balanced solutions was associated with high probability of a small reduction in-hospital mortality (estimated number needed to treat of 250 to prevent one death), however, it probably increased mortality in those with traumatic brain injury
Source:
The Lancet Respiratory Medicine
SPS commentary:
Commentary suggests the one-size-fits-all approach for crystalloid fluid choice should now finally be discontinued, with transition to a targeted patient-centred fluid choice in critical care. It notes that for those with traumatic brain injury, keeping sodium concentrations constant is crucial; this may explain the tipping of the scale in favour of 0.9% saline with regard to mortality in this group of patients. It adds that there may be other subgroups of critically ill patients, yet to be identified, whose outcomes could be positively influenced by the choice of crystalloid fluid.