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Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU?

Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating... Opinion EDITORIAL Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU? Michael J. Connor Jr, MD; Craig M. Coopersmith, MD Administration of intravenous fluids is among the most com- ized 2278 patients to examine whether fluid type affected mon interventions performed in intensive care units (ICUs). outcomes. No between-group differences were detected for the The first description of fluids for resuscitation of a critically primary outcome of acute kidney injury or for the secondary out- ill patient occurred during the 1830s cholera outbreak in comes of kidney replacement therapy or mortality. England. In the 200 years since, debates continue surround- In contrast, the Isotonic Solutions and Major Adverse ing the volume, composition, and rate of fluid administra- Renal Events Trial (SMART) examined 15 802 patients who re- tion, with few definitive answers to guide clinicians. ceived balanced crystalloids (either lactated ringer solution or Previous studies have demonstrated that mortality is de- Plasma-Lyte A) or saline (0.9% sodium chloride) in a single- creased when critically ill patients receive early fluid resuscita- center, multiple ICU, pragmatic, cluster-randomized, multiple- 2,3 4 13 tion during septic shock and hemorrhagic shock, although crossover trial. The trial http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU?

JAMA , Volume 326 (9) – Sep 7, 2021

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Publisher
American Medical Association
Copyright
Copyright 2021 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2021.11119
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU? Michael J. Connor Jr, MD; Craig M. Coopersmith, MD Administration of intravenous fluids is among the most com- ized 2278 patients to examine whether fluid type affected mon interventions performed in intensive care units (ICUs). outcomes. No between-group differences were detected for the The first description of fluids for resuscitation of a critically primary outcome of acute kidney injury or for the secondary out- ill patient occurred during the 1830s cholera outbreak in comes of kidney replacement therapy or mortality. England. In the 200 years since, debates continue surround- In contrast, the Isotonic Solutions and Major Adverse ing the volume, composition, and rate of fluid administra- Renal Events Trial (SMART) examined 15 802 patients who re- tion, with few definitive answers to guide clinicians. ceived balanced crystalloids (either lactated ringer solution or Previous studies have demonstrated that mortality is de- Plasma-Lyte A) or saline (0.9% sodium chloride) in a single- creased when critically ill patients receive early fluid resuscita- center, multiple ICU, pragmatic, cluster-randomized, multiple- 2,3 4 13 tion during septic shock and hemorrhagic shock, although crossover trial. The trial

Journal

JAMAAmerican Medical Association

Published: Sep 7, 2021

References