Tags

Type your tag names separated by a space and hit enter

Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial.
Trials. 2017 04 13; 18(1):178.T

Abstract

BACKGROUND

Prior studies in critically ill patients suggest the supra-physiologic chloride concentration of 0.9% ("normal") saline may be associated with higher risk of renal failure and death compared to physiologically balanced crystalloids. However, the comparative effects of 0.9% saline and balanced fluids are largely unexamined among patients outside the intensive care unit, who represent the vast majority of patients treated with intravenous fluids.

METHODS/DESIGN

This study, entitled Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED), is a pragmatic, cluster, multiple-crossover trial at a single institution evaluating clinical outcomes of adults treated with 0.9% saline versus balanced crystalloids for intravenous fluid resuscitation in the emergency department. All adults treated in the study emergency department receiving at least 500 mL of isotonic crystalloid solution during usual clinical care and subsequently hospitalized outside the intensive care unit are included. Treatment allocation of 0.9% saline versus balanced crystalloids is assigned by calendar month, with study patients treated during the same month assigned to the same fluid type. The first month (January 2016) was randomly assigned to balanced crystalloids, with each subsequent month alternating between 0.9% saline and balanced crystalloids. For balanced crystalloid treatment, clinicians can choose either Lactated Ringer's or Plasma-Lyte A©. The study period is set at 16 months, which will result in an anticipated estimated sample size of 15,000 patients. The primary outcome is hospital-free days to day 28, defined as the number of days alive and out of the hospital from the index emergency department visit until 28 days later. Major secondary outcomes include proportion of patients who develop acute kidney injury by creatinine measurements; major adverse kidney events by hospital discharge or day 30 (MAKE30), which is a composite outcome of death, new renal replacement therapy, and persistent creatinine elevation >200% of baseline; and in-hospital mortality.

DISCUSSION

This ongoing pragmatic trial will provide the most comprehensive evaluation to date of clinical outcomes associated with 0.9% saline compared to physiologically balanced fluids in patients outside the intensive care unit.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02614040 . Registered on 18 November 2015.

Authors+Show Affiliations

Department of Emergency Medicine, 1313 21st Avenue South, 703 Oxford House, Nashville, TN, 37220, USA. wesley.self@vanderbilt.edu.Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA.Department of Anesthesiology, Nashville, TN, USA. Department of Biomedical Informatics, Nashville, TN, USA.Department of Anesthesiology, Nashville, TN, USA. Department of Biomedical Informatics, Nashville, TN, USA.Department of Biostatistics, Nashville, TN, USA.Department of Biostatistics, Nashville, TN, USA.Department of Pharmaceutical Services, All at Vanderbilt University Medical Center, Nashville, TN, USA.Department of Pharmaceutical Services, All at Vanderbilt University Medical Center, Nashville, TN, USA.Department of Emergency Medicine, 1313 21st Avenue South, 703 Oxford House, Nashville, TN, 37220, USA.Department of Emergency Medicine, 1313 21st Avenue South, 703 Oxford House, Nashville, TN, 37220, USA.Department of Anesthesiology, Nashville, TN, USA.Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA.Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, TN, USA.

Pub Type(s)

Comparative Study
Journal Article
Pragmatic Clinical Trial
Randomized Controlled Trial

Language

eng

PubMed ID

28407811

Citation

Self, Wesley H., et al. "Saline Versus Balanced Crystalloids for Intravenous Fluid Therapy in the Emergency Department: Study Protocol for a Cluster-randomized, Multiple-crossover Trial." Trials, vol. 18, no. 1, 2017, p. 178.
Self WH, Semler MW, Wanderer JP, et al. Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials. 2017;18(1):178.
Self, W. H., Semler, M. W., Wanderer, J. P., Ehrenfeld, J. M., Byrne, D. W., Wang, L., Atchison, L., Felbinger, M., Jones, I. D., Russ, S., Shaw, A. D., Bernard, G. R., & Rice, T. W. (2017). Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials, 18(1), 178. https://doi.org/10.1186/s13063-017-1923-6
Self WH, et al. Saline Versus Balanced Crystalloids for Intravenous Fluid Therapy in the Emergency Department: Study Protocol for a Cluster-randomized, Multiple-crossover Trial. Trials. 2017 04 13;18(1):178. PubMed PMID: 28407811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. AU - Self,Wesley H, AU - Semler,Matthew W, AU - Wanderer,Jonathan P, AU - Ehrenfeld,Jesse M, AU - Byrne,Daniel W, AU - Wang,Li, AU - Atchison,Leanne, AU - Felbinger,Matthew, AU - Jones,Ian D, AU - Russ,Stephan, AU - Shaw,Andrew D, AU - Bernard,Gordon R, AU - Rice,Todd W, Y1 - 2017/04/13/ PY - 2016/12/12/received PY - 2017/03/29/accepted PY - 2017/4/15/entrez PY - 2017/4/15/pubmed PY - 2018/3/21/medline KW - Crystalloid KW - Emergency department KW - Intravenous fluids KW - Pragmatic trial KW - Renal failure KW - Saline SP - 178 EP - 178 JF - Trials JO - Trials VL - 18 IS - 1 N2 - BACKGROUND: Prior studies in critically ill patients suggest the supra-physiologic chloride concentration of 0.9% ("normal") saline may be associated with higher risk of renal failure and death compared to physiologically balanced crystalloids. However, the comparative effects of 0.9% saline and balanced fluids are largely unexamined among patients outside the intensive care unit, who represent the vast majority of patients treated with intravenous fluids. METHODS/DESIGN: This study, entitled Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED), is a pragmatic, cluster, multiple-crossover trial at a single institution evaluating clinical outcomes of adults treated with 0.9% saline versus balanced crystalloids for intravenous fluid resuscitation in the emergency department. All adults treated in the study emergency department receiving at least 500 mL of isotonic crystalloid solution during usual clinical care and subsequently hospitalized outside the intensive care unit are included. Treatment allocation of 0.9% saline versus balanced crystalloids is assigned by calendar month, with study patients treated during the same month assigned to the same fluid type. The first month (January 2016) was randomly assigned to balanced crystalloids, with each subsequent month alternating between 0.9% saline and balanced crystalloids. For balanced crystalloid treatment, clinicians can choose either Lactated Ringer's or Plasma-Lyte A©. The study period is set at 16 months, which will result in an anticipated estimated sample size of 15,000 patients. The primary outcome is hospital-free days to day 28, defined as the number of days alive and out of the hospital from the index emergency department visit until 28 days later. Major secondary outcomes include proportion of patients who develop acute kidney injury by creatinine measurements; major adverse kidney events by hospital discharge or day 30 (MAKE30), which is a composite outcome of death, new renal replacement therapy, and persistent creatinine elevation >200% of baseline; and in-hospital mortality. DISCUSSION: This ongoing pragmatic trial will provide the most comprehensive evaluation to date of clinical outcomes associated with 0.9% saline compared to physiologically balanced fluids in patients outside the intensive care unit. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02614040 . Registered on 18 November 2015. SN - 1745-6215 UR - https://www.unboundmedicine.com/medline/citation/28407811/Saline_versus_balanced_crystalloids_for_intravenous_fluid_therapy_in_the_emergency_department:_study_protocol_for_a_cluster_randomized_multiple_crossover_trial_ DB - PRIME DP - Unbound Medicine ER -