SALT-ED
Trial question
What is the effect of balanced crystalloids in noncritically ill patients treated with intravenous fluids in the emergency department?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
52.0% female
48.0% male
N = 13347
13347 patients (6886 female, 6461 male).
Inclusion criteria: noncritically ill patients who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU.
Key exclusion criteria: receipt of < 500 ml of crystalloids in the emergency department, age < 18 years, discharge from emergency department.
Interventions
N=6708 balanced crystalloids (infusion of lactated Ringer's solution or Plasma-Lyte A).
N=6639 normal saline (infusion of 0.9% saline).
Primary outcome
Hospital-free days
25 days
25 days
25.0 days
18.8 days
12.5 days
6.3 days
0.0 days
Balanced
crystalloids
Normal
saline
No significant
difference ↔
No significant difference in hospital-free days (25 days vs. 25 days; OR 0.98, 95% CI 0.92 to 1.04).
Secondary outcomes
Significant decrease in the rate of major adverse kidney events within 30 days (4.7% vs. 5.6%; OR 0.82, 95% CI 0.7 to 0.95).
No significant difference in stage 2 or higher AKI (8% vs. 8.6%; OR 0.91, 95% CI 0.8 to 1.03).
No significant difference in death in the hospital (1.4% vs. 1.6%; OR 0.88, 95% CI 0.66 to 1.16).
Safety outcomes
No significant differences in death, new RRT, final serum creatinine ≥ 200% of baseline.
Conclusion
In noncritically ill patients who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU, balanced crystalloids were not superior to normal saline with respect to a hospital-free days.
Reference
Wesley H Self, Matthew W Semler, Jonathan P Wanderer et al. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med. 2018 Mar 1;378(9):819-828.
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