Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  29 (2025)
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 28 , ISSUE 11 ( November, 2024 ) > List of Articles

Original Article

Salt Based or BaLanced SolUtion–Trends Existing in Indian Intensive Care Units: A Multicenter Prospective Observational Cohort Study (SOLUTE Study)

Sachin Gupta, Subhal Dixit, Deeksha S Tomar, Kapil Zirpe, Deepak Govil, Dhruva Choudhry, Yatin Mehta, Anand Gupta, Lakkireddigari Siva Kumar Reddy, Adarsh Singamsetty, Sarala Kumari Daram, Pooja R Murthy, Venkatesha Gupta KV, Pratibha Dileep, Kapildev Thakkar, Sweta J Patel, Divya Pal, Naveen Paliwal, Pooja Bihani, Lakshmikanthcharan Saravana Bavan, Sivakumar MN, Sourabh S Ambapkar, Saanvi S Ambapkar, Yogendra Pal Singh, Akhil Taneja, Rajeeb K Mishra, Suparna Bharadwaj, Anuj Clerk, Krunalkumar Patel, Mehul Shah, Zakariya Kaidawala

Keywords : Acute kidney injury, Balanced salt solution, ICU length of stay, Normal saline

Citation Information : Gupta S, Dixit S, Tomar DS, Zirpe K, Govil D, Choudhry D, Mehta Y, Gupta A, Reddy LS, Singamsetty A, Daram SK, Murthy PR, KV VG, Dileep P, Thakkar K, Patel SJ, Pal D, Paliwal N, Bihani P, Bavan LS, MN S, Ambapkar SS, Ambapkar SS, Singh YP, Taneja A, Mishra RK, Bharadwaj S, Clerk A, Patel K, Shah M, Kaidawala Z. Salt Based or BaLanced SolUtion–Trends Existing in Indian Intensive Care Units: A Multicenter Prospective Observational Cohort Study (SOLUTE Study). Indian J Crit Care Med 2024; 28 (11):1028-1037.

DOI: 10.5005/jp-journals-10071-24825

License: CC BY-NC 4.0

Published Online: 30-10-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Fluid administration is a commonly practiced intervention in the intensive care unit (ICU) with normal saline being the preferred fluid. We sought to understand the current practice of fluid administration and choice of fluids in Indian ICUs and its effect on renal outcomes. Materials and methods: The Indian Society of Critical Care Medicine (ISCCM)-endorsed multicenter prospective observational study was conducted on practice of fluid administration in critically ill patients between May 1, 2020, and January 31, 2023. SPSS software was used for statistical analysis. Results: Private sector hospitals contributed 79.16% of data out of 144 ICUs. Around 961 patients belonged to the normal saline (NS) group, 672 to the Ringer's lactate (RL) group, and 891 to the balanced salt solution (BSS) group out of 2,452 patients. Patients with chronic obstructive pulmonary disease were more in the BSS and NS group as compared to RL group (p < 0.00001). Acute kidney injury (AKI) incidence was higher in the NS group, followed by RL and BSS (p < 0.0001). The serum creatinine rise was higher in the NS group on the first 2 days (p < 0.001). Daily fluid balance, urine output, and renal replacement therapy (RRT) needs were similar among the groups. The BSS group had shorter ICU and hospital length of stay (LOS) than the NS group (p < 0.001). The ICU survival was 63.3% in the NS group and 79.44% in the BSS group (p < 0.001). The AKI patients had higher survival in the BSS group (78.81%) as compared to the NS group (63.08%) (p < 0.001). Conclusion: Balanced salt solution is the preferred intravenous fluid with a safe renal profile among critically ill patients. The AKI patients had shorter hospital and ICU LOS with BSS as compared to NS.

HTML PDF Share
  1. Yunos NM, Kim IB, Bellomo R, Bailey M, Ho L, Story D, et al. The biochemical effects of restricting chloride-rich fluids in intensive care. Crit Care Med 2011;39(11):2419–2424. DOI: 10.1097/CCM.0b013e31822571e5.
  2. Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012;308(15):1566–1572. DOI: 10.1001/jama.2012.13356.
  3. Zayed YZM, Aburahma AMY, Barbarawi MO, Hamid K, Banifadel MRN, Rashdan L, et al. Balanced crystalloids versus isotonic saline in critically ill patients: Systematic review and meta-analysis. J Intensive Care 2018;6:51. DOI: 10.1186/s40560-018-0320-x.
  4. Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, et al. Intensive care in India: The Indian intensive care case mix and practice patterns study. Indian J Crit Care Med 2016;20:216–225. DOI: 10.4103/0972-5229.180042.
  5. Young P, Bailey M, Beasley R, Henderson S, Mackle D, McArthur C, et al. SPLIT Investigators; ANZICS CTG. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: The SPLIT randomized clinical trial. JAMA 2015;314(16):1701–1710. DOI: 10.1001/jama.2015.12334.
  6. Finfer S, Liu B, Taylor C, Bellomo R, Billot L, Cook D, et al. SAFE TRIPS Investigators. Resuscitation fluid use in critically ill adults: An international cross-sectional study in 391 intensive care units. Crit Care 2010;14(5):R185. DOI: 10.1186/cc9293.
  7. Semler MW, Wanderer JP, Ehrenfeld JM, Stollings JL, Self WH, Siew ED, et al. SALT Investigators * and the Pragmatic Critical Care Research Group; SALT Investigators. Balanced crystalloids versus saline in the intensive care unit. The SALT randomized trial. Am J Respir Crit Care Med 2017;195(10):1362–1372. DOI: 10.1164/rccm.201607-1345OC.
  8. Verma B, Luethi N, Cioccari L, Lloyd-Donald P, Crisman M, Eastwood G, et al. A multicentre randomised controlled pilot study of fluid resuscitation with saline or Plasma-Lyte 148 in critically ill patients. Crit Care Resusc 2016;18(3):205–212. DOI: 10.1016/S1441-2772(23)00947-X.
  9. Zwager CL, Tuinman PR, de Grooth HJ, Kooter J, Ket H, Fleuren LM, et al. Why physiology will continue to guide the choice between balanced crystalloids and normal saline: A systematic review and meta-analysis. Crit Care 2019;23(1):366. DOI: 10.1186/s13054-019-2658-4.
  10. Finfer S, Micallef S, Hammond N, Navarra L, Bellomo R, Billot L, et al. PLUS Study Investigators and the Australian New Zealand Intensive Care Society Clinical Trials Group. Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med 2022;386(9):815–826. DOI: 10.1056/NEJMoa2114464.
  11. Self WH, Semler MW, Wanderer JP, Wang L, Byrne DW, Collins SP, et al. SALT-ED Investigators. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 2018;378(9):819–828. DOI: 10.1056/NEJMoa1711586.
  12. Shaw AD, Raghunathan K, Peyerl FW, Munson SH, Paluszkiewicz SM, Schermer CR. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med 2014;40(12):1897–1905. DOI: 10.1007/s00134-014-3505-3.
  13. Wang N, Jiang L, Zhu B, Wen Y, Xi XM, Beijing Acute Kidney Injury Trial (BAKIT) Workgroup. Fluid balance and mortality in critically ill patients with acute kidney injury: A multicenter prospective epidemiological study. Crit Care 2015;19:371. DOI: 10.1186/s13054-015-1085-4.
  14. Mehta RL, Bouchard J. Controversies in acute kidney injury: Effects of fluid overload on outcome. Contrib Nephrol 2011;174:200–211. DOI: 10.1159/000329410.
  15. Wang P, Huang Y, Li J, Cao D, Chen B, Chen Z, et al. Balanced crystalloid solutions versus normal saline in intensive care units: A systematic review and meta-analysis. Int Urol Nephrol 2023;55(11):2829–2844. DOI: 10.1007/s11255-023-03570-9.
  16. Hammond DA, Lam SW, Rech MA, Smith MN, Westrick J, Trivedi AP, et al. Balanced crystalloids versus saline in critically ill adults: A systematic review and meta-analysis. Ann Pharmacother 2020;54(1):5–13. DOI: 10.1177/1060028019866420.
  17. Raghunathan K, Shaw A, Nathanson B, Stürmer T, Brookhart A, Stefan MS, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*. Crit Care Med 2014;42(7):1585–1591. DOI: 10.1097/CCM.0000000000000305.
  18. Liu C, Lu G, Wang D, Lei Y, Mao Z, Hu P, et al. Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: A systematic review and meta-analysis with trial sequential analysis. Am J Emerg Med 2019;37(11):2072–2078. DOI: 10.1016/j.ajem.2019.02.045.
  19. Ostermann M, Randolph AG. Resuscitation fluid composition and acute kidney injury in critical illness. N Engl J Med 2022;386(9):888–889. DOI 10.1056/NEJMe2200294.
  20. Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al. Acute Kidney Injury in Critical Illness Study Group. Association of hyperchloremia with hospital mortality in critically ill septic patients. Crit Care Med 2015;43(9):1938–1944. DOI: 10.1097/CCM. 0000000000001161.
  21. Yessayan L, Neyra JA, Canepa-Escaro F, Vasquez-Rios G, Heung M, Yee J; Acute Kidney Injury in Critical Illness Study Group. Effect of hyperchloremia on acute kidney injury in critically ill septic patients: A retrospective cohort study. BMC Nephrol 2017;18(1):346. DOI: 10.1186/s12882-017-0750-z.
  22. Scioscia A, Horvat C, Moritz ML, Fuhrman D. Balanced crystalloids versus normal saline in children with critical asthma. Children (Basel) 2022;9(10):1480. DOI: 10.3390/children9101480.
  23. Barhight MF, Brinton J, Stidham T, Soranno DE, Faubel S, Griffin BR, et al. Increase in chloride from baseline is independently associated with mortality in critically ill children. Intensive Care Med 2018;44(12):2183–2191. DOI: 10.1007/s00134-018-5424-1.
  24. Trepatchayakorn S, Sakunpunphuk M, Samransamruajkit R. Balanced salt solution versus normal saline in resuscitation of pediatric sepsis: A randomized, controlled trial. Indian J Pediatr 2021;88(9):921–924. DOI: 10.1007/s12098-021-03808-3. E.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.