Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline in Critically Ill Patients
BaSICS trial design and results
Design
Multicentre randomised clinical trial with a factorial design testing fluid type and infusion speed
Treatment
Balanced crystalloid solution
Control
0.9% saline
Population
10,520 analysed critically ill patients, mean age 61.1, 44.2% women; 48.4% planned surgical admissions
Follow-up
90 days
Primary endpoint
90-day survival
Result
There was no significant interaction between fluid type and infusion speed (p=0.98), and no significant difference in 90-day survival between balanced solution and saline. Of all patients, 60.6% had hypotension or vasopressor use and 44.3% required mechanical ventilation.
Secondary endpoints
Acute kidney injury, renal replacement therapy, need for mechanical ventilation
Among critically ill patients requiring fluid challenges, use of a balanced solution compared with 0.9% saline solution did not significantly reduce 90-day mortality. The findings do not support the use of this balanced solution.
The trial authors, in the published abstract
How it has aged
Larger than PLUS and concordant with it. Nearly half the population were planned surgical admissions, which dilutes the sickest patients in whom a chloride effect might plausibly matter — the standing objection, and one PLUS largely answers.
Publications
Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial
Zampieri FG, Machado FR, Biondi RS, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA 2021 Aug 10;326(9):1-12.
No significant difference in 90-day survival
No interaction between fluid type and infusion speed