title: Saline versus Plasma-Lyte A in initial resuscitation of trauma patients: a randomized trial.
abstract: OBJECTIVE
  We sought to compare resuscitation with 0.9% NaCl versus Plasma-Lyte A, a calcium-free balanced crystalloid solution, hypothesizing that Plasma-Lyte A would better correct the base deficit 24 hours after injury.
  
  
  BACKGROUND
  Sodium chloride (0.9%) (0.9% NaCl), though often used for resuscitation of trauma patients, may exacerbate the metabolic acidosis that occurs with injury, and this acidosis may have detrimental clinical effects.
  
  
  METHODS
  We conducted a randomized, double-blind, parallel-group trial (NCT01270854) of adult trauma patients requiring blood transfusion, intubation, or operation within 60 minutes of arrival at the University of California Davis Medical Center. Based on a computer-generated, blocked sequence, subjects received either 0.9% NaCl or Plasma-Lyte A for resuscitation during the first 24 hours after injury. The primary outcome was mean change in base excess from 0 to 24 hours. Secondary outcomes included 24-hour arterial pH, serum electrolytes, fluid balance, resource utilization, and in-hospital mortality.
  
  
  RESULTS
  Of 46 evaluable subjects (among 65 randomized), 43% had penetrating injuries, injury severity score was 23 ± 16, 20% had admission systolic blood pressure less than 90 mm Hg, and 78% required an operation within 60 minutes of arrival. The baseline pH was 7.27 ± 0.11 and base excess -5.9 ± 5.0 mmol/L. The mean improvement in base excess from 0 to 24 hours was significantly greater with Plasma-Lyte A than with 0.9% NaCl {7.5 ± 4.7 vs 4.4 ± 3.9 mmol/L; difference: 3.1 [95% confidence interval (CI): 0.5-5.6]}. At 24 hours, arterial pH was greater [7.41 ± 0.06 vs 7.37 ± 0.07; difference: 0.05 (95% CI: 0.01-0.09)] and serum chloride was lower [104 ± 4 vs 111 ± 8 mEq/L; difference: -7 (95% CI: -10 to -3)] with Plasma-Lyte A than with 0.9% NaCl. Volumes of study fluid administered, 24-hour urine output, measures of resource utilization, and mortality did not significantly differ between the 2 arms.
  
  
  CONCLUSIONS
  Compared with 0.9% NaCl, resuscitation of trauma patients with Plasma-Lyte A resulted in improved acid-base status and less hyperchloremia at 24 hours postinjury. Further studies are warranted to evaluate whether resuscitation with Plasma-Lyte A improves clinical outcomes.
authors.affiliation: From the Department of Surgery, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Young
authors.forename: Garth H
authors.initials: GH
authors.lastname: Utter
authors.forename: Carol R
authors.initials: CR
authors.lastname: Schermer
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.forename: Ho H
authors.initials: HH
authors.lastname: Phan
authors.forename: Yifan
authors.initials: Y
authors.lastname: Yang
authors.forename: Brock A
authors.initials: BA
authors.lastname: Anderson
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Scherer
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000628:therapy*; D000328:Adult; D004311:Double-Blind Method; D004573:Electrolytes / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007552:Isotonic Solutions; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010952:Plasma Substitutes / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods*; D012965:Sodium Chloride / Q000627:therapeutic use*; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D004573:Electrolytes; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012965:Sodium Chloride; C048013:Plasmalyte A