Key result
The authors argue that large randomized clinical trials comparing saline to balanced solutions may be unnecessary and potentially misleading, advocating instead for individualized fluid therapy based on patient metabolic status.
The authors argue against the necessity of clinical trials comparing saline to balanced crystalloid solutions, advocating instead for individualized fluid therapy based on patient electrolyte levels.
Some of our colleagues believe that everything should be tested in prospective, randomized clinical trials. Some of our colleagues also believe that so-called pragmatic trials can help improve the care of critically ill patients. The designs of such studies are based on the postulate that patients are all the same and will be globally either improved or harmed by one strategy compared with another. This may be true for some interventions but is certainly not true for all, including choice of crystalloid solution.
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Vincent et al. (2016) conducted an editorial in Critically ill patients requiring intravenous fluids. Saline vs balanced crystalloid solutions was evaluated. The authors argue that large randomized clinical trials comparing saline to balanced solutions may be unnecessary and potentially misleading, advocating instead for individualized fluid therapy based on patient metabolic status.
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