Saline as Effective as Balanced Electrolyte Solutions in the ICU

A new study on intravenous (IV) fluids used in the intensive care unit (ICU) shows that commonly used saline is as effective as the more expensive balanced multielectrolyte solution (BMES) in critically ill adults.

Researchers at the George Institute for Global Health (Sydney, Australia), Royal Melbourne Hospital (RMH; Australia), the Medical Research Institute of New Zealand (MRINZ; Wellington, New Zealand), and other institutions conducted a study involving 5,037 patients treated at 53 ICUs in Australia and New Zealand; of these, 2,515 were assigned to the BMES (Plasma-Lyte 148) group, and 2,522 to the saline (0.9% NaCl) group. The main outcome was death from any cause within 90 days of randomization.


The results showed that death within 90 days occurred in 21.8% in the BMES group and in 22% in the saline group. New renal-replacement therapy was initiated in 12.7% in the BMES group and in 12.9% in the saline group. Mean maximum increase in serum creatinine level was 36.6 μmol/L in the BMES group and 36.1 μmol/L in the saline group. The number of adverse and serious adverse events did not differ meaningfully between the groups. The study was published on January 18, 2022, in New England Journal of Medicine (NEJM).

“Just about every patient admitted to the ICU will receive IV fluids for resuscitation or as part of standard treatment. However, the best choice of fluid has been a longstanding issue of debate,” said senior author Professor Simon Finfer, AO, of The George Institute. “We found no evidence that using a BMES reduced risk of death or acute kidney injury in critically ill adults. Our researchers have changed the way the medical world thinks about IV fluids, and have demonstrated that the choice of fluid should be treated with the same care and attention as the prescription of any drug.”

Plasma-Lyte 148, a product of Baxter International (Baxter, Deerfield, IL, USA), is an isotonic, buffered BMES crystalloid solution with a physiochemical composition closely reflecting human plasma. It is physiologically different to the other commonly available crystalloids solutions such as Hartmann’s solution and saline. Use of BMES has increased since concerns were raised about increased rates of kidney injury and death associated with saline.

Related Links:
George Institute for Global Health
Royal Melbourne Hospital
Medical Research Institute of New Zealand
Baxter International