The Crystalloid Debate

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8 • 678 Ratings

🗓️ 12 March 2018

⏱️ 22 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient?

Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them.

In the podcast we cover the following;

Whats the big deal with crystalloids
Previous trials on fluid administration
NEJM papers on crystalloids
Myburgh's editorial

Make sure you take a look at the papers yourself and come up with your own conclusions. There are a whole host of superb FOAM resources out there on the topic that are well worth a look and referenced below.

We'd love to hear any thoughts and comments below.

Enjoy!

Simon & Rob

References & Further Reading

Fluid	Na	K	Cl	Ca	Mg	Lact	Acet	Glucon	Dext	Osmol mOsm/L
0.9% N Saline	154	0	154	0	0	0	0	0	0	308
Lactated Ringers	131	5	11	2.7	0	29	0	0	0	273
Hartmanns	129	5	109	4	0	29	0	0	0	278
Plasma Lyte	140	5	98	0	3	0	27	23	0	280

Constituents measured in mEq/L Reference; University Texas

Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW. N Engl J Med. 2018

Balanced Crystalloids versus Saline in Noncritically Ill Adults. Self WH. N Engl J Med. 2018

Patient-Centered Outcomes and Resuscitation Fluids. Myburgh J. N Engl J Med. 2018

REBEL.EM; Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?

PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation

JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn’s

JC: So long Salt and Saline? St Emlyn’s

The Bottom Line; SALT-EM

The Bottom Line; SMART

Transcript

Click on a timestamp to play from that location

0:00.0	Welcome to the Recess Room podcast.
0:03.9	Five, four, three, two, one, fire.
0:13.3	So hi, and welcome back to the Recess Room podcast.
0:16.8	I'm Simon Lang, and I'm Rob Fenwick.
0:19.7	And we're back to talk to you about something which is exceptionally topical and will affect no doubt all of your practice.
0:27.9	What are we talking about Rob?
0:29.4	We are talking about administration of crystalloid Simon. Can't think how many times a day I do that.
0:35.7	Well, I doubt you administer it much at all.
0:37.8	I do. I'm certainly able to.
0:39.9	I absolutely do on occasion administer my own crystalloid, yeah?
0:43.5	I also, of course, more predominantly prescribe it.
0:46.7	Yeah, absolutely.
0:47.6	And the thinking that goes in to prescribing with fluids
0:51.7	is probably not quite as much that would go into other prescribing.
0:55.7	And it tends to be a bit of a knee-jerk reaction to write down a fluid, write down a volume,
1:00.5	and then think about the rating which you're giving it. But there's some new publications
1:04.6	which shed new light on the topic and we're going to cover that and see how that's going
1:08.9	to affect your prescribing and your usage of crystalloids.
1:13.5	Before we start, a huge thanks, yes again, to AdPrak for sponsoring the podcast.
1:19.0	Thanks also to Nigel Taylor, who provides all the IT and support for the research stream,
1:23.5	and also for the Critical Appraisal Lowdown course,
1:26.5	which is our new podcast-cented course, bringing you right through a syllabus on Critical Appraisal Lowdown course, which is our new podcast-cented course,
	...

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