March 2, 2018

Ditching saline IVs could save 50,000 lives each year, studies suggest

Daily Briefing

    Using balanced fluids, rather than saline, in IVs could save tens of thousands of lives annually and reduce the prevalence of serious kidney problems, according to two studies published in the New England Journal of Medicine.

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    Saline, or salt mixed into water, has been the most-commonly used fluid for IVs in the United States for more than 100 years. Balanced fluids include saline as well as other components, such as potassium, that make them more similar to plasma, the colorless fluid part of blood.

    About the studies

    The studies compared the outcomes of Vanderbilt University patients who received IVs of saline with those who received IVs of balanced fluids, such as lactated Ringer's solution or Plasma-Lyte A. One study looked at nearly 16,000 critically ill ICU patients, while the other examined more than 13,000 non-critically ill patients who received an IV in the ED and were later hospitalized outside the ICU.

    Findings

    Overall, the studies found about a 1% reduction in deaths or serious kidney problems in the groups that received balanced fluids rather instead of saline.

    Specifically, of the critically ill ICU patients:

    • 10.3% who received balanced fluids died compared with 11.1% of those who received saline; and
    • 14.3% of the balanced fluids group developed serious kidney problems compared with 15.4% of the saline group.

    Of the non-critically ill hospitalized patients, 4.7% of the balanced fluids group developed a serious kidney problem compared with 5.6% of the saline group. The researchers found no difference in how early patients in each group were discharged.

    The researchers estimated that more widespread adoption of balanced fluids in IV bags in the United States could lead to between 50,000 and 70,000 fewer deaths and about 100,000 fewer cases of kidney failure per year. 

    Discussion

    Matthew Semler, an author on the study and an assistant professor of medicine at Vanderbilt University School of Medicine, said, "Because balanced fluids and saline are similar in cost, the finding of better patient outcomes with balanced fluids in two large trials has prompted a change in practice at Vanderbilt toward using primarily balanced fluids for intravenous fluid therapy."

    Wesley Self, an author on the study and an associate professor of emergency medicine, said that while the difference is small for individual patients, it is "significant on a population level. Each year in the United States, millions of patients receive intravenous fluids."

    John Kellum, a critical care specialist at the University of Pittsburgh who was not involved in the study, said he and others have been "sounding the alarm for 20 years" on the possible negative effects of using saline, adding that "it's purely inertia" that is preventing more widespread use of balanced fluids.

    However, John Myburgh of the University of New South Wales and St. George Hospital in Sydney in an editorial accompanying the study expressed skepticism that "the results of an open-label trial conducted in a single, major U.S. medical center can be generalized to the ways in which their own patients survive, feel, and function" (AP/CBS News, 2/28; Nedelman, CNN, 2/28; Commins, HealthLeaders Media, 2/28; Hackethal, Medscape, 2/28).

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