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In 2018, a large, pragmatic, single-center trial demonstrated lower mortality and fewer renal injuries in patients who received balanced crystalloid (a solution with chloride levels closer to plasma levels) than in those who received normal saline (NEJM JW Gen Med Apr 15 2018 and N Engl J Med 2018; 378:819, 829). Although the differences were small, the results prompted many clinicians to change practice and preferentially use balanced crystalloid for resuscitation. A subsequent multicenter trial from Brazil did not confirm these results (JAMA 2021; 326:1).
In this latest trial from Australia and New Zealand, investigators randomized more than 5000 critically ill patients in who required fluid resuscitation to receive either normal saline or…