Posted on 02/28/2018 6:34:29 PM PST by BenLurkin
SAN ANTONIO -- Hospitalized patients given IV balanced fluids instead of saline showed a roughly 1% decreased incidence of death and serious kidney injury, according to results of two studies that compared outcomes with the two widely used IV trauma therapies.
The improved outcomes, seen in both critically ill and non-critically ill patients, suggest that largely replacing saline with balanced fluids in the hospital setting could result in significant mortality and morbidity reductions, said Matthew W. Semler, MD, of Vanderbilt University Medical Center in Nashville, in a presentation at the Society of Critical Care Medicine (SCCM) annual meeting. The results were simultaneously published in the New England Journal of Medicine.
...
Buchman 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.
The chloride concentration of saline is higher than that of human plasma. Balanced fluids, by contrast, are basically plasma electrolytes with some water. "After roughly 75 years of intravenous medicine and 50 years of advanced trauma life support, we are finally recognizing that maybe what we should be giving is what the patient has been losing," Buchman said.
(Excerpt) Read more at medpagetoday.com ...
The cost difference between LR and NS is negligble. If I were the patient in ER I would opt for NS. Very few drugs are incompatible with NS but many are with LR. In the ER in a critical situation you have no idea what drug you may need to push into the iv line next. Better to hang NS first and later you can change to other iv fluids if needed.
1% is not a valid statistical difference and it should be noted the study “made assumptions” with their data sets.
I would confine this study to the category of “interesting but of no value at this time.”
If you are in a life threatening situation, would you not want something very easy to do, that appears to raise your odds of survival an additional one percent?
I would. Basically they are sayig they have a better electrolyte solution than the standard saline solution. The body being a living battery, it makes sense a superior electroyte solution will provide better life support than a lesser one. when you are at risk of dying you take every edge you can get to remaining alive especially when they are this easy to do.
the two studies together looked at a total of little more than 29,000 patients.
Following a car accident many years ago, I was on ringer’s lactate for 9 months. No other fluids or food except for occasional blood transfusions. I went down to 45 lbs, but lived to tell the tale.
I am a fan of ringers lactate.
Which is why it us misleading. Within the margin of error means they don’t know. And they are willing to customize a treatment based on false assumptions which may be completely wrong. It could be that the proposed treatment is harmful instead of helpful.
Have you read their two papers?
No. But I do understand measurement error and statistics. And conditions are rarely precise enough to predict an event with 1% accuracy. Especially when there are dozens of variables and hundreds of patient types and conditions.
Conditions that are not controlled or even fully understood.
I am just skeptical.
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