Research Calls for Switch to Balanced IVs from Saline IVs

Balanced IV fluids ready to go at a hospital

Researchers at Vanderbilt University Medical Center (VUMC) recently released two landmark studies that showed patients long-term survival increased and kidney complications decreased when balanced fluids were used for hospital patients rather than traditional saline.

The Vanderbilt team followed approximately 28,000 intensive care and emergency center patients for two years and determined that switching from saline to balanced fluids could save between 50,000 and 70,000 lives in the U.S. annually and reduce cases of kidney failure by 100,000.

What’s more, negative outcomes like death or kidney failure were lowered by roughly 1 percent in patients who received the balanced solution such as lactated Ringer’s solution or Plasma-Lyte A, versus a standard 0.9% saline IV. Given that so many patients receive intravenous fluids, even a 1 percent improvement could impact tens of thousands of lives.

Study author Wesley Self, MD, MPH, associate professor of emergency medicine told the VUMC Reporter, “The difference, while small for individual patients, is significant on a population level. Each year in the United States, millions of patients receive intravenous fluids.”

As a result of these studies, Vanderbilt is in the process of switching to using balanced fluids in the ER and on the wards, and found the cost is approximately the same, $1 to $2 per IV.

“These studies should be brought to the attention of physician leaders and the interdisciplinary team without delay to discuss how the findings will affect hospital practice and if changes should be implemented,” said Jennifer Seagle, PharmD, Area Clinical Manager. “IV fluid replacement is one of the first treatments initiated upon hospital admission in the majority of patients. Large-scale research such as this only helps improve the quality of care we provide in our institutions.”

One physician in attendance at a presentation of these study results at the Society of Critical Care Medicine (SCCM) annual meeting in San Antonio in late February 2018 called the information “practice-changing.”

Critical care specialist Timothy Buchman, MD, of Emory Healthcare in Atlanta, told MedPage Today said the historical rationale for giving 0.9% saline was that it was compatible with blood transfusions. “But we have reduced the need for blood dramatically in so many (hospital) situations,” he said.

Balanced fluids more closely mimic the levels of sodium, potassium and chloride normally found in plasma. Balanced fluids are already widely used in Europe and Australia and in the U.S. are often preferred by surgeons and anesthesiologists.

The Vanderbilt studies are further supported by another study presented at the SCCM by pediatric critical care specialist Erin Stenson, MD, of Cincinnati Children’s Hospital. Stenson found that in 900 children with septic shock, hyperchloremia was associated with higher mortality and poorer outcomes. As a result, many physicians at Cincinnati Children’s are switching from saline to lactated Ringer’s for resuscitation.

The Vanderbilt studies, titled Balanced Crystalloids versus Saline in Noncritically Ill Adults and Balanced Crystalloids versus Saline in Critically Ill Adults, were published in the March 1st edition of the New England Journal of Medicine.

The Cincinnati Children’s study is titled Hyperchloremia Is Associated With Complicated Course and Mortality in Pediatric Patients With Septic Shock and was published in the February 2018 edition of Pediatric Critical Care Medicine.

You can learn more about the studies at SALT-ED number, NCT02614040.