Hey folks, Scott Wangart here and this is a breaking news we just published today.

The basics trial on fluid choices and fluid administration rate.

In the JAMA, publishes two separate papers and you'll want to know what it says.

So let's get the rest of the M. Crit team, Josh Farcus, a.k.a.

Homecrit and Rory Spiegel in this case, CC nerd or EM nerd sometimes.

And let's hear what the trial showed.

Who could, which of you two think they could just give a two minute description of what these two trials showed?

What do you go for it, Rory?

Sure.

Go for it.

So basically, this is built off the idea that balanced solutions are potentially more beneficial than chloride rich solutions like normal saline and lead to less kidney failure and then morbidity and mortality due to that.

And then the secondary analysis, they also looked, which I thought was fairly interesting, the speed at which we give a bulls randomizing patients to either get their bulls at 99.

999 billion is an hour versus 333.

So a rather fast bulls versus an intermediate bull to see if a fast bulls let to let to more third spacing, more interstitial demon, so on and so forth.

And so essentially a massive trial over 10,000 patients randomized to the two arms.

And the enrollment, they basically, I think we're selecting a group of patients that had the potential to be harmed by chloride rich solutions because some of the critique of earlier trials is these patients weren't really at that risk didn't really get a large volume.

And so, you know, any benefit wouldn't be found in these studies.

So they looked at patients greater than 65 with acute kidney injury with cirrhosis with sepsis, basically trying to identify the group of patients that were fairly high risk and then they were randomized to either plasma light or normal saline, which was the blinded part of the arm, the rate of the infusion was non blinded.

And essentially it looked like a fairly good randomization, the groups look fairly balanced, they got a fairly significant amount of fluid, I think 1.5 liters, about two liters of fluid over the first 24 hours and about three liters over the course of the next three days.

So the bulk of it was the solution they were randomized to, so 1.5 out of two liters.

Large portion of them were septic, I think greater than 50% were either hypertensive on vasopressors and about 44% of each arm were mechanically ventilated.

So all in all, I think fairly representative of what we see in the ICUs and who we think may or may not benefit from balanced solutions.

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