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

Sam Roberts
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DOI: https://doi.org/10.7861/clinmedicine.18-3-267a
Clin Med June 2018
Sam Roberts
ST6 respiratory/general medicine, Leeds Institute of Health Sciences and Leeds Institute of Medical Education, University of Leeds, UK
Roles: clinical leadership fellow to the Physician Associate Programme
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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.

  • © Royal College of Physicians 2018. All rights reserved.

References

  1. ↵
    1. Tidswell R
    , Singer M. Sepsis – thoughtful management for the non-expert. Clin Med 2018;18:62–8.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Self WH
    , Semler MW, Wanderer JP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 2018;378:819–28.
    OpenUrl
  3. ↵
    1. Semler MW
    , Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018;378:829–39.
    OpenUrl
  4. ↵
    1. Shaw AD
    , Schermer CR, Lobo DN, et al. Impact of intravenous fluid composition on outcomes in patients with systemic inflammatory response syndrome. Critical Care 2015;19:334.
    OpenUrl
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Which crystalloid? Does fluid choice influence patient outcomes in sepsis?
Sam Roberts
Clinical Medicine Jun 2018, 18 (3) 267-268; DOI: 10.7861/clinmedicine.18-3-267a

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Which crystalloid? Does fluid choice influence patient outcomes in sepsis?
Sam Roberts
Clinical Medicine Jun 2018, 18 (3) 267-268; DOI: 10.7861/clinmedicine.18-3-267a
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