Balanced Crystalloids in the Critically Ill
Semler MW, Self WH, Wanderer JP, et al; SMART Investigators and the Pragmatic Critical
Care Research Group. Balanced crystalloids versus saline in critically ill adults. N Engl J Med
2018;378:829–39.
Applications for Clinical Practice
Overall, this trial clarifies an important gap in knowledge regarding fluid choice in the care of critically ill adults. The composite outcome of death, persistent renal dysfunction, and new RRT was significantly lower when a balanced fluid was used in comparison with saline. The ease of implementation, low financial impact, and epidemiologically significant renal outcomes supports a consideration for change in practice. However, clinicians should evaluate implementation on a case-by-case basis. More studies evaluating MAKE30 outcomes individually in specific diagnoses and clinical contexts are necessary. Moreover, data on long-term MAKE outcomes would help characterize long-term public health implications of 30-day effects.
—Divya Padmanabhan Menon, MD, Christopher L. Trautman, MD, and Neal M. Patel, MD, Mayo Clinic, Jacksonville, FL
