Balanced crystalloids versus saline in critically ill adults with low plasma bicarbonate : A secondary analysis of a clinical trial
Copyright © 2021. Published by Elsevier Inc..
PURPOSE: We aimed to determine if balanced crystalloids compared with saline improve outcomes in critically ill adults admitted with low plasma bicarbonate.
MATERIALS AND METHODS: We performed a secondary analysis of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART). We included patients who presented to the Emergency Department with a first measured plasma bicarbonate less than 20 mmol/L. Among these patients, we compared the effect of balanced crystalloid versus saline on the primary outcome of major adverse kidney events within 30 days (MAKE30), defined as a composite of death, new renal-replacement therapy, or persistent renal dysfunction (final inpatient creatinine ≥200% baseline). Secondary outcomes included 30 day in-hospital mortality, receipt of new RRT, persistent renal dysfunction, incident AKI, and vasopressor-free days.
RESULTS: Among the 2029 patients with an initial plasma bicarbonate concentration < 20 mmol/L, there was no difference in the incidence of MAKE30 between those assigned to balanced crystalloid versus saline (21.8% vs 21.3%; P = 0.93). Secondary outcomes were similar between the balanced crystalloid and saline groups.
CONCLUSIONS: Among critically ill adults presenting to the Emergency Department, initial plasma bicarbonate concentration does not appear to be a useful marker to guide the selection of balanced crystalloid versus saline.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:63 |
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| Enthalten in: |
Journal of critical care - 63(2021) vom: 04. Juni, Seite 250-253 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Brems, J Henry [VerfasserIn] |
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| Links: |
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| Themen: |
Acidosis |
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| Anmerkungen: |
Date Completed 30.09.2021 Date Revised 05.11.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2020.12.016 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320619796 |
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| 100 | 1 | |a Brems, J Henry |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Balanced crystalloids versus saline in critically ill adults with low plasma bicarbonate |b A secondary analysis of a clinical trial |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 30.09.2021 | ||
| 500 | |a Date Revised 05.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021. Published by Elsevier Inc. | ||
| 520 | |a PURPOSE: We aimed to determine if balanced crystalloids compared with saline improve outcomes in critically ill adults admitted with low plasma bicarbonate | ||
| 520 | |a MATERIALS AND METHODS: We performed a secondary analysis of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART). We included patients who presented to the Emergency Department with a first measured plasma bicarbonate less than 20 mmol/L. Among these patients, we compared the effect of balanced crystalloid versus saline on the primary outcome of major adverse kidney events within 30 days (MAKE30), defined as a composite of death, new renal-replacement therapy, or persistent renal dysfunction (final inpatient creatinine ≥200% baseline). Secondary outcomes included 30 day in-hospital mortality, receipt of new RRT, persistent renal dysfunction, incident AKI, and vasopressor-free days | ||
| 520 | |a RESULTS: Among the 2029 patients with an initial plasma bicarbonate concentration < 20 mmol/L, there was no difference in the incidence of MAKE30 between those assigned to balanced crystalloid versus saline (21.8% vs 21.3%; P = 0.93). Secondary outcomes were similar between the balanced crystalloid and saline groups | ||
| 520 | |a CONCLUSIONS: Among critically ill adults presenting to the Emergency Department, initial plasma bicarbonate concentration does not appear to be a useful marker to guide the selection of balanced crystalloid versus saline | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Acidosis | |
| 650 | 4 | |a Balanced crystalloid | |
| 650 | 4 | |a Bicarbonate | |
| 650 | 4 | |a Saline | |
| 650 | 7 | |a Bicarbonates |2 NLM | |
| 650 | 7 | |a Crystalloid Solutions |2 NLM | |
| 650 | 7 | |a Isotonic Solutions |2 NLM | |
| 700 | 1 | |a Casey, Jonathan D |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Li |e verfasserin |4 aut | |
| 700 | 1 | |a Self, Wesley H |e verfasserin |4 aut | |
| 700 | 1 | |a Rice, Todd W |e verfasserin |4 aut | |
| 700 | 1 | |a Semler, Matthew W |e verfasserin |4 aut | |
| 700 | 0 | |a SMART Investigators and the Pragmatic Critical Care Research Group |e verfasserin |4 aut | |
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| 773 | 1 | 8 | |g volume:63 |g year:2021 |g day:04 |g month:06 |g pages:250-253 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jcrc.2020.12.016 |3 Volltext |
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