Nephrology in critical care · Choice of crystalloid
Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults
| Design | Multicentre, double-blind randomised controlled trial |
|---|---|
| Treatment | Balanced multielectrolyte solution |
| Control | 0.9% saline |
| Population | 5037 patients from 53 ICUs in Australia and New Zealand: 2515 balanced solution and 2522 saline |
| Follow-up | 90 days |
| Primary endpoint | Death from any cause within 90 days |
| Result | Death within 90 days occurred in 530 of 2433 (21.8%) with balanced solution and 530 of 2413 (22.0%) with saline — a difference of -0.15 percentage points. There was no difference in acute kidney injury. New renal-replacement therapy was started in 306 of 2403 (12.7%) with balanced solution and 310 of 2394 (12.9%) with saline — difference -0.20 percentage points (95% CI -2.96 to 2.56). |
| Secondary endpoints | Acute kidney injury, renal replacement therapy, days alive and out of hospital |
We found no evidence that the risk of death or acute kidney injury among critically ill adults in the ICU was lower with the use of BMES than with saline.
The trial authors, in the published abstract
Along with BaSICS, it closed a decade-long argument over chloride-rich fluid. The physiological case against saline was strong and the clinical difference turns out to be negligible — a pattern that recurs whenever a plausible mechanism meets an adequately powered trial.
Finfer S, Micallef S, Hammond N, et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. N Engl J Med 2022 Mar 3;386(9):815-826.