No difference between Balanced Crystalloids versus Saline in critical care

Isotonic saline is the most commonly used crystalloid in the ICU. There is some evidence that chloride rich solution use (saline) may be associated with increased risk of renal injury as well as death.

Matthew W. Semler, Jonathan P. Wanderer et el just published a  cluster-randomized, multiple-crossover trial comparing saline with balanced crystalloids in a single tertiary care hospital(SALT study).

What they did

Saline (0.9% sodium chloride) and balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) were used in all coming patients in intensive care unit on alternative months.  Data for total of 974 patients were analyzed using their EMR.

Primary outcome was proportion of saline use which was higher in the saline group (91% vs. 21%; P < 0.001). Secondary outcome was  major adverse kidney events within 30 days (MAKE30).

There was no difference in the MAKE30 outcome among the two groups.


Ongoing trials,  the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) (NCT02444988) ,  the Plasma-Lyte 148 versus Saline Trial (PLUS) (NCT02721654) and saline vs balanced crystalloids in ED, SALT-ED ( NCT02614040 ) will answer the question and hopefully settle the matter.

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