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To buffer or not buffer your resuscitation fluid

A prior JAMA published study using historical control suggested that buffered solutions used in resuscitation reduce AKI. I must admit I became a big fan of LR and plasmalyte thereafter. But the recent very well done SPLIT trial, an RCT by the ANZICS group using blinding and crossover design shows no difference in any of the clinical outcomes including AKI or mortality.

Young et al. JAMA 2015 - Online only at present. doi:10.1001/jama.2015.12334.


Probably, the take home message I got was that low total volumes of NS probably have same AKI outcomes as plasmalyte.  Its was a well designed study, but did not really add much to our understanding of large volume resuscitation, since the median amount given was about 2 L.

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