As remarked by the authors of the recent PLUS trial, a systematic review and meta-analysis of randomized controlled trials comparing balanced resuscitation fluid to 0.9% saline was reported in the New England Journal of Medicine Evidence.

This methodical tour de force was crucial given the outwardly incongruous conclusions of the SMART, SPLIT, BaSICS and PLUS trials.

Might the small mortality benefits observed in some of these large randomized trials become significant with greater statistical power?

Might a Bayesian paradigm give us a slightly different perspective when thinking about the lumped results?

Given the hundreds of millions of litres of IV fluid administered every year, even very small effect sizes could have implications at the population level.

Thus, the authors of the systematic review and meta-analysis approached their synthesis with the following question: in critically-ill adults, does the use of balanced crystalloid solutions compared with 0.9% saline reduce mortality and/or the occurrence of acute kidney injury?

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