Spring 2013 DIG Report: Karthik Raghunathan, MD, MPH

Comparative effectiveness in Perioperative and Critical Care Medicine: Crystalloid Fluid Therapy

Balanced salt solutions are often used for the treatment of dehydration among patients undergoing surgical procedures, while intravenous saline solutions are the most commonly used fluid among patients with serious infections.

Our preliminary analysis of over 50,000 patients with serious infections admitted to intensive care units in over 300 hospitals across the United States between 2005-2010 shows that the use of balanced salt solutions is safer than the use of intravenous saline. In addition, there is a ‘dose-response’ relationship, such that as the proportion of balanced salt solutions increases instead of saline, the risk of death decreases. For instance, if patients receive five liters of fluid over the first day in the hospital, those receiving all five liters as balanced salt solutions do better than those receiving four liters of balanced salt solution with one liter of saline and so on. In this scenario, patients that receive five liters of saline have the worst outcomes.