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Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial.
Ann Emerg Med. 2019 02; 73(2):160-169.AE

Abstract

STUDY OBJECTIVE

The purpose of this study is to test the hypothesis that balanced crystalloids improve quality of recovery more than normal saline solution (0.9% sodium chloride) in stable emergency department (ED) patients. Secondary outcomes measured differences in health care use.

METHODS

A single-site, participant- and evaluator-blinded, 2-arm parallel allocation (1:1), comparative effectiveness, randomized controlled trial allocated adults receiving intravenous fluids in the ED before discharge to receive 2 L of lactated Ringer's solution or normal saline solution. The primary outcome was symptom scores measured by the validated Quality of Recovery-40 instrument (scores 40 to 200) 24 hours after enrollment. Secondary outcomes included subsequent health care use and medication compliance.

RESULTS

Participants (N=157) were enrolled and follow-up was analyzed for 94 (follow-up rate of 60%) with intention-to-treat methodology. There was no difference in postenrollment Quality of Recovery-40 scores between normal saline solution and lactated Ringer's solution groups (mean difference 2.4; 95% confidence interval [CI] -6.8 to 11.6). Although preenrollment scores were higher in the lactated Ringer's solution group (mean difference 10.5; 95% CI 1.9 to 19.0), adjusting for presurvey imbalances did not change the primary outcome (adjusted difference -3.9; 95% CI -12.9 to 5.2). There were no differences in return to ED (mean difference 7.5%; 95% CI -8.7% to 23.8%), prescriptions filled (mean difference 22.2%; 95% CI -3.3% to 47.6%), or seeking care from another provider (mean difference -2.0%; 95% CI -19.9% to 15.9%) at 7 days.

CONCLUSION

Normal saline solution and lactated Ringer's solution were associated with similar 24-hour recovery scores and 7-day health care use in stable ED patients. These results supplement those of recent trials by informing fluid choice for stable ED patients.

Authors+Show Affiliations

Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Pharmaceutical Care, University of Iowa Carver College of Medicine, Iowa City, IA.Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: nicholas-mohr@uiowa.edu.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30146446

Citation

Friederich, Andrew, et al. "Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect On Quality of Recovery: a Randomized Controlled Trial." Annals of Emergency Medicine, vol. 73, no. 2, 2019, pp. 160-169.
Friederich A, Martin N, Swanson MB, et al. Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial. Ann Emerg Med. 2019;73(2):160-169.
Friederich, A., Martin, N., Swanson, M. B., Faine, B. A., & Mohr, N. M. (2019). Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial. Annals of Emergency Medicine, 73(2), 160-169. https://doi.org/10.1016/j.annemergmed.2018.07.007
Friederich A, et al. Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect On Quality of Recovery: a Randomized Controlled Trial. Ann Emerg Med. 2019;73(2):160-169. PubMed PMID: 30146446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Normal Saline Solution and Lactated Ringer's Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial. AU - Friederich,Andrew, AU - Martin,Natalie, AU - Swanson,Morgan B, AU - Faine,Brett A, AU - Mohr,Nicholas M, Y1 - 2018/08/23/ PY - 2018/04/18/received PY - 2018/06/20/revised PY - 2018/07/09/accepted PY - 2018/8/28/pubmed PY - 2018/8/28/medline PY - 2018/8/28/entrez SP - 160 EP - 169 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 73 IS - 2 N2 - STUDY OBJECTIVE: The purpose of this study is to test the hypothesis that balanced crystalloids improve quality of recovery more than normal saline solution (0.9% sodium chloride) in stable emergency department (ED) patients. Secondary outcomes measured differences in health care use. METHODS: A single-site, participant- and evaluator-blinded, 2-arm parallel allocation (1:1), comparative effectiveness, randomized controlled trial allocated adults receiving intravenous fluids in the ED before discharge to receive 2 L of lactated Ringer's solution or normal saline solution. The primary outcome was symptom scores measured by the validated Quality of Recovery-40 instrument (scores 40 to 200) 24 hours after enrollment. Secondary outcomes included subsequent health care use and medication compliance. RESULTS: Participants (N=157) were enrolled and follow-up was analyzed for 94 (follow-up rate of 60%) with intention-to-treat methodology. There was no difference in postenrollment Quality of Recovery-40 scores between normal saline solution and lactated Ringer's solution groups (mean difference 2.4; 95% confidence interval [CI] -6.8 to 11.6). Although preenrollment scores were higher in the lactated Ringer's solution group (mean difference 10.5; 95% CI 1.9 to 19.0), adjusting for presurvey imbalances did not change the primary outcome (adjusted difference -3.9; 95% CI -12.9 to 5.2). There were no differences in return to ED (mean difference 7.5%; 95% CI -8.7% to 23.8%), prescriptions filled (mean difference 22.2%; 95% CI -3.3% to 47.6%), or seeking care from another provider (mean difference -2.0%; 95% CI -19.9% to 15.9%) at 7 days. CONCLUSION: Normal saline solution and lactated Ringer's solution were associated with similar 24-hour recovery scores and 7-day health care use in stable ED patients. These results supplement those of recent trials by informing fluid choice for stable ED patients. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/30146446/Normal_Saline_Solution_and_Lactated_Ringer's_Solution_Have_a_Similar_Effect_on_Quality_of_Recovery:_A_Randomized_Controlled_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(18)30627-9 DB - PRIME DP - Unbound Medicine ER -