Fluid trials

 

SAFE 2004

Question

Albumin vs saline for resuscitation

Type

·      Multi-centre, double blinded RCT

Subjects

·      ICU patients

Upshot

·      ↑Mortality if TBI (although small subgroup)

·      ↔Mortality otherwise

·      ↔Organ failure

·      ↔Ventilation time

·      ↔Length of stay

·      ↑RBC transfusion (? ↑haemodilution ? ↑blood loss)

 

NICE-SUGAR 2009

Question

Intensive vs conventional glucose control in the critically ill

Type

·      Multi-national, non-blinded RCT

Subjects

·      ICU patients

Upshot

·      ↑Severe hypoglycaemic events

·      ↑Mortality

 

CHEST 2012

Question

Hydroxyethylstarch vs saline for resuscitation

Type

·      multi-national, double blinded RCT

Subjects

·      ICU patients

Upshot

·      ↑Renal failure

·      ↑Mortality

 

PIMS 2014

Question

Isotonic vs hypotonic in paediatrics

Type

·      Single-centre, double-blinded RCT

Subjects

·      Med and surg paediatric inpatients

Groups

·      Plasmalyte vs half-normal-saline-in-50%-dextrose

Upshot

·      ↓Hyponatraemia in isotonic group

·      No cerebral oedema in either group

·      Less K+ replacement required after surgery (released by damaged cells)

What fluid to use?

·      Resus: NS 10mL/kg

·      Maintenance if well: plasmalyte and K 4:2:1

·      Maintenance if sick: plasmalyte and K 2:1:0.5 if sick

Risk factors for hyponatraemia

·      Neonate

·      Craniofacial surgery

·      Neurosurgery

 

RELIEF 2018

Question

Restrictive vs liberal fluids for major abdo surgery

Background

·      Too little -> ? organ hypoperfusion e.g. AKI

·      Too much -> ? surgical complications e.g. dehiscence

Type

·      Multi-national, assessor-blinded RCT

Subjects

·      High risk patients undergoing major elective abdo surgery

Groups

·      Induction: 1mL/kg vs 5mL/kg

·      Maintenance: 8mL/kg/h vs 5mL/kg/h

·      Post-op til 24h: 1.5mL/kg/h vs 0.8mL/kg/h

Upshot

·      ↑AKI and RRT

·      ↑Surgical site infection

·      (refer to Goldilocks story)

 

SMART 2018

Question

Normal saline vs balanced solutions

Background

·      Maybe saline rogers the kidneys

Type

·      Single centre RCT

Subjects

·      ICU patients

Upshot

·      ↑RRT

·      ↑Persistent renal dysfx

(small differences)

 

SALT-ED 2018

Question

Normal saline vs balanced solutions

Background

·      Maybe saline rogers the kidneys

Type

·      Single centre RCT

Subjects

·      A&E patients

Upshot

·      ↑Creatinine, especially if a) pre-existing CKD b) ↑Cl-

 

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