Balanced crystalloids vs saline for critically ill patients

Editor’s Comment

For a very long time, normal saline has been the go-to crystalloid in most ICUs around the globe. In the recent past, evidence started mounting about the potential downside of this solution. The recent SMART trial, the largest to date, indicates that we could prevent adverse renal outcomes by choosing balanced crystalloids over normal saline. These results were even more marked in patients who received a large amount of crystalloids and in patients with sepsis. Dr. Matthew Semler presents solid arguments to consider in changing our practice and adopting a “balanced approach” to fluid resuscitation. We certainly should not only worry about the amount of fluids infused but also about the type of solution we give our patients. Hopefully, we will soon learn if the different balanced solutions also lead to outcome differences.

Angel Coz, MD, FCCP – Section Editor