Switching IV fluids could save thousands of lives

ICU patients on these fluids inside hospital also died at lower rates within the 30 days. The study authors said in which generating the switch could save tens of thousands of lives among the millions who get these fluids inside hospital every year.

“Saline has been used in practice for over a century,” said study author Dr. Todd W. Rice, director of the medical intensive care unit at Vanderbilt University Medical Center as well as an associate professor of medicine in its Division of Allergy, Pulmonary, as well as Critical Care Medicine.

“We actually heard via quite a few people in which there couldn’t have been much difference between these two (intravenous fluids), because we would likely have already known the idea if there was.”

Of nearly 16,000 critically ill patients, 10.3% of those given balanced crystalloids as well as 11.1% of those given saline died inside hospital within a month. Serious kidney events arose in 14.3% of the “balanced” group as well as 15.4% inside saline group.

On the various other hand, the study of more than 13,000 patients who were not critically ill found in which there was no difference in how early surviving patients were discharged inside four weeks after they came to the emergency room. yet the researchers did find a slightly lower incidence of serious kidney events: 4.7% for the “balanced” group versus 5.6% for those receiving saline. This specific means 111 saline patients would likely need to be treated with balanced crystalloids instead in order to prevent one adverse kidney event.

Though these numbers may be substantial when looking at the country as a whole, Rice said the idea’s not a reason to worry for an individual who finds themselves attached to a saline drip.

“For any one patient, the risk is actually pretty modest,” he said.

IV bags can contain any number of ingredients, such as fluids, sugars as well as medications. yet many patients are dehydrated, as well as in which’s where saline as well as “lactated ringers,” the most common balanced crystalloid, come in handy.

“We’ve tried to do a lot of history-looking to figure out why saline became the default,” Rice said. “the idea’s not entirely clear.”

Neither IV fluid tends to cost more than the various other, as well as both have been widely available for decades, the researchers said.

These fluids are meant to mirror salt concentrations in human blood, keeping water where the idea needs to be in order to better hydrate the body, according to Rice. (This specific is actually partly why chicken soup is actually often recommended for those who are sick, experts say.)

Saline consists of sodium chloride — the main ingredient in common table salt — dissolved in water. Lactated ringers contain several additional ions, such as calcium as well as potassium.

Research has suggested in which a higher chloride concentration in saline can affect kidney function as well as lead to metabolic problems. However, a couple of smaller studies recently failed to show a difference between the two fluids, Rice said.
“This specific study makes me think again about what choice of fluids I’ll use at This specific point,” said Dr. David Hager, associate director of the medical ICU at the Johns Hopkins Hospital. Hager was not involved inside fresh studies.

Hager said he believes in which various other studies will spin off via This specific research, which was conducted at an individual medical center. He also noted in which the research was unblinded, meaning in which doctors “knew they were giving one fluid versus another, as well as in which may have an impact on various other decisions in which they make.”

Patients who were not critically ill — who received IV fluids inside emergency room — did not necessarily receive the same fluid after being admitted to the hospital, the researchers said.

“in which was actually quite a surprise to us,” Rice said, as well as This specific could be because some patients receive the majority of these IV fluids inside emergency department.

the idea could also have something to do with being more vulnerable inside early stages of an illness, he said.

Doctors may still opt for saline if, for example, a patient has low concentrations of sodium or chloride, Rice said. Many of his colleagues who treat brain injuries are also wary of using lactated ringers over saline because of its potential impact on the pressure within the skull, he added.

“They get very very worried about increased swelling,” Rice said. More research could uncover which types of patients are most sensitive to the effect of one fluid over another, he said.

Though Vanderbilt’s hospital system has made modifications to prioritize the balanced crystalloid, Rice said the idea could be a long time before This specific becomes standard practice.

“Change is actually slow in medicine — slower than any of us believe the idea should be,” he said. “We’re trying to get the message out.”

Switching IV fluids could save thousands of lives

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