The Crystalloid Debate

How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient?

Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them.

In the podcast we cover the following;

• Whats the big deal with crystalloids
• Previous trials on fluid administration
• NEJM papers on crystalloids
• Myburgh's editorial

Make sure you take a look at the papers yourself and come up with your own conclusions. There are a whole host of superb FOAM resources out there on the topic that are well worth a look and referenced below.

We'd love to hear any thoughts and comments below.

Enjoy!

Simon & Rob

References & Further Reading

Fluid Na K Cl Ca Mg Lact Acet Glucon Dext

Osmol

mOsm/L

0.9% N Saline 154 0 154 0 0 0 0 0 0 308 Lactated Ringers 131 5 11 2.7 0 29 0 0 0 273 Hartmanns 129 5 109 4 0 29 0 0 0 278 Plasma Lyte 140 5 98 0 3 0 27 23 0 280

Constituents measured in mEq/L Reference; University Texas 

Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW. N Engl J Med. 2018

Balanced Crystalloids versus Saline in Noncritically Ill Adults. Self WH. N Engl J Med. 2018

Patient-Centered Outcomes and Resuscitation Fluids. Myburgh J. N Engl J Med. 2018

REBEL.EM; Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?

PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation

JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn’s

JC: So long Salt and Saline? St Emlyn’s

The Bottom Line; SALT-EM

The Bottom Line; SMART