Balanced Crystalloids versus Saline in Noncritically Ill Adults.
Balanced Crystalloids versus Saline in Noncritically Ill Adults.
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DOI：
10.1056/nejmoa1711586
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发表时间：
2018-03-01
期刊：
影响因子：
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通讯作者：
SALT-ED Investigators
中科院分区：
文献类型：
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作者：
Self WH;Semler MW;Wanderer JP;Wang L;Byrne DW;Collins SP;Slovis CM;Lindsell CJ;Ehrenfeld JM;Siew ED;Shaw AD;Bernard GR;Rice TW;SALT-ED Investigators
平衡晶体和生理盐水的比较临床效果尚不确定，特别是在重症监护病房(ICU)外护理的非危重患者中。我们进行了一项单中心、实用、多交叉试验，比较了在急诊科接受静脉注射晶体的成年人和随后在ICU外住院的成年人中平衡晶体(乳酸林格液或血浆-赖特A)和生理盐水的差异。在为期16个月的试验中，急诊科给每个患者分配的晶体类型是以日历月为基础的，整个急诊科每月在平衡晶体和生理盐水之间交换。主要结果是无住院天数(出院后第28天前的存活天数)。次要结果包括30天内的主要不良肾脏事件-任何原因死亡、新的肾脏替代治疗或持续性肾功能障碍(定义为肌酐水平上升至基线的200%)-所有在出院时或30天内进行审查，以最先发生的为准。共有13,347名患者入选，急诊科接受晶体体积的中位数为1079毫升，88.3%的患者只接受指定的晶体。平衡晶体组和生理盐水组的无住院天数没有差异(中位数，每组25天；平衡晶体调整后的优势比为0.98；95%可信区间[CI]为0.92至1.04；P=0.41)。平衡晶体在30天内的主要不良肾脏事件发生率低于生理盐水(4.7%比5.6%；调整后优势比0.82；95%可信区间0.70至0.95；P=0.01)。在急诊科接受静脉输液治疗的非危重成年人中，平衡晶体治疗和生理盐水治疗的无住院天数没有差异。
Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU). We conducted a single-center, pragmatic, multiple-crossover trial comparing balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) with saline among adults who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU. The type of crystalloid that was administered in the emergency department was assigned to each patient on the basis of calendar month, with the entire emergency department crossing over between balanced crystalloids and saline monthly during the 16-month trial. The primary outcome was hospital-free days (days alive after discharge before day 28). Secondary outcomes included major adverse kidney events within 30 days — a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) — all censored at hospital discharge or 30 days, whichever occurred first. A total of 13,347 patients were enrolled, with a median crystalloid volume administered in the emergency department of 1079 ml and 88.3% of the patients exclusively receiving the assigned crystalloid. The number of hospital-free days did not differ between the balanced-crystalloids and saline groups (median, 25 days in each group; adjusted odds ratio with balanced crystalloids, 0.98; 95% confidence interval [CI], 0.92 to 1.04; P = 0.41). Balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days than saline (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P = 0.01). Among noncritically ill adults treated with intravenous fluids in the emergency department, there was no difference in hospital-free days between treatment with balanced crystalloids and treatment with saline.