New research on intravenous fluids used in intensive care shows that commonly used saline is as effective at keeping people alive and their organs functioning as more expensive balanced solutions.
The results not only provide doctors with greater certainty about the safety and benefits of saline solution, but also have broader implications for treatment availability and costs around the world.
“Just about every patient admitted to the Intensive Care Unit (ICU) will receive intravenous fluids for resuscitation or as part of standard treatment,” said Professor Simon Finfer AO, an ICU physician and senior researcher at The George Institute.
“However, the best choice of fluid has been a longstanding issue of debate as some fluids were approved and licensed for use based on trials in small numbers of patients looking only at short term outcomes.”
Plasma-Lyte 148® is a type of intravenous fluid that more closely matches the body’s normal levels of certain minerals, known as balanced multi-electrolyte solutions, or BMES. Use of BMES has risen since concerns were raised about increased rates of kidney injury and death associated with saline, although this had not been proven in clinical trials.
To address this issue, the Plasma-Lyte 148® versUs Saline (PLUS) study recruited over 5000 patients across 53 sites in Australia and New Zealand.
Participants were adult patients admitted to ICUs in need of intravenous fluid resuscitation for their underlying medical condition. The patients were followed for a period of 90 days after treatment as previous research had shown around one in four would be at risk of dying within this timeframe.
At 90 days after the treatment, the same number of patients who had received BMES or saline had died.
Other outcomes including days of mechanical ventilation, kidney dialysis, patient survival time in the ICU and in hospital, as well as major measures of healthcare costs were similar between the groups.
“We found no evidence that using a balanced multi-electrolyte solution in the ICU, compared to saline, reduced risk of death or acute kidney injury in critically ill adults,” said Prof Finfer.
ICU is one of the most expensive aspects of healthcare and ICU resources are in high demand. Even a small difference in outcomes may result in important clinical and economic effects at the population level.
In the early 1990s, up to one in seven people were dying in ICUs across Australia and New Zealand, prompting George Institute researchers to start investigating intravenous fluid resuscitation – one of the most commonly used treatments in intensive care settings.
This started a program of fluid resuscitation research conducted in ICUs that no-one previously thought possible which has resulted in major changes to clinical treatment guidelines worldwide, preventing harmful practices and saving many lives.
The results from this study were published in the New England Journal of Medicine.
Source: EurekAlert!
