Which crystalloid? Does fluid choice influence patient outcomes in sepsis?

Editor – I read with interest the informative review by Tidswell and Singer regarding the definition, pathophysiology, diagnosis and management of sepsis.¹

The article correctly highlights that the issue of fluid choice for patients with sepsis is a key dilemma for both researchers and clinicians. The authors suggest that there is little to recommend one crystalloid over another as first-line resuscitation fluid.

Two recent studies have added to the increasing body of evidence that balanced crystalloid solutions are associated with improved outcomes compared to 0.9% saline for all patients.^2,3 These support existing evidence focusing exclusively on patients with sepsis, indicating better outcomes in patients managed with balanced crystalloids.⁴

There are clear limitations to the available evidence and studies vary according to inclusion criteria, design and outcome measurement. Any treatment choice must take into account patient-specific factors such as serum potassium levels and further research is needed to facilitate informed clinical decision making. However, it would appear that currently the balance of evidence is tipping in favour of balanced crystalloids and against 0.9% saline as the optimal resuscitation fluid for most patients.