Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial

SPS commentary:

A separate report of this study in JAMA notes that use of a balanced solution (Plasma-Lyte 148) did not reduce 90 day mortality vs 0.9% sodium chloride (26.4% vs 27.2%, HR 0.97, 95%CI 0.90-1.05).

A related editorial discusses this research.  It notes that of the 2 fluid interventions in the trial, the rate of fluid administration is more straightforward to interpret; while there are physiological rationales to support either slower or faster fluid administration, both strategies represent viable approaches for critically ill patients who require at least 1 episode of volume expansion but generally have low need for additional fluids.

It adds that with regards to solution type used in this setting, these results, combined with the results from previous trials, demonstrate no measurable risk for administration of 0.9% sodium chloride when used in small to moderate quantities in critically ill patients who are at relatively low risk for acute kidney injury. Clinicians should feel confident in using any type of isotonic crystalloid in this setting.  Despite multiple studies that have compared fluid type, there continues to be insufficient data to guide management in critically ill patients who require significant volume resuscitation. Although there are theoretical reasons to suggest that balanced solutions may offer a benefit in a more severely ill patient population, the paucity of controlled data from rigorous clinical trials in this population precludes a recommendation.