I have discussed the ongoing battle between normal saline and ‘balanced fluids’ many times in the past. First, there was the SPLIT trial, a double blind cluster RCT of 2200 ICU patients that showed no difference between saline and Plasma-Lyte 148. (Young 2015)

Next, we had the SMART trial, an unblinded cluster RCT of 15,000 ICU patients, which showed a difference in their composite outcome of major adverse kidney events, but had numerous issues (and a fragility index of 0). (Semler 2018)

The SALT-ED trial was performed simultaneously, and was an unblinded cluster RCT of 20,000 emergency department patients, and showed no difference in their primary outcome of hospital free days. (Self 2018)

Finally, we covered the BaSICS trial, a double blind RCT of 11,000 ICU patients that showed no difference in mortality between normal saline and Plasma Lyte 148. (Zampieri 2021)

I imagine most people are pretty bored with this topic, but there are still some people with very strong opinions.

It is not uncommon to hear people claim that saline is killing patients, despite strong evidence to the contrary.

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