Today in my daily reading I came across this study:
Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults
Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M
JAMA. 2012;308:1566-1572
The long and short of it is they compared Cl- content in fluid therapy for volume resuscitation.
I found it very interesting because the conclusion was that lower Cl- fluids like lactated ringers showed no significant change in mortality.
However, they did show a significant reduction in AKI. (Which is very important not only for quality of life, but for cost as well, dialysis is expensive)
When I first started my career, for the treatment of shock, lactated ringers was the prefered solution in EMS. We weren't ever told why, only that it is.
Some years later, in the effort to save money, it was decided since studies showed no difference in 90 day mortality, it was chaper just to stock saline. (0.9%)
For years in both EMS and ED settings, saline became the "go-to" solution for resucitation. After all, in the emergency medicine "all or nothing" mentality, mortality was the same.
Now this study by itself is not without flaw and certainly not overly convincing.
But looking into it a little deeper, it seems consistently stated in both surgery and anesthesia literature that lactated ringers is the prefered solution in shock responsive to chrystalloid.
So maybe it does matter?
So, let us take a head count of what is going on.
(note, multiple answers are selectable, please only select what you have available to you, not what you wish you had)
Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults
Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M
JAMA. 2012;308:1566-1572
The long and short of it is they compared Cl- content in fluid therapy for volume resuscitation.
I found it very interesting because the conclusion was that lower Cl- fluids like lactated ringers showed no significant change in mortality.
However, they did show a significant reduction in AKI. (Which is very important not only for quality of life, but for cost as well, dialysis is expensive)
When I first started my career, for the treatment of shock, lactated ringers was the prefered solution in EMS. We weren't ever told why, only that it is.
Some years later, in the effort to save money, it was decided since studies showed no difference in 90 day mortality, it was chaper just to stock saline. (0.9%)
For years in both EMS and ED settings, saline became the "go-to" solution for resucitation. After all, in the emergency medicine "all or nothing" mentality, mortality was the same.
Now this study by itself is not without flaw and certainly not overly convincing.
But looking into it a little deeper, it seems consistently stated in both surgery and anesthesia literature that lactated ringers is the prefered solution in shock responsive to chrystalloid.
So maybe it does matter?
So, let us take a head count of what is going on.
(note, multiple answers are selectable, please only select what you have available to you, not what you wish you had)
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