title: Time to resuscitate a sacred cow...with normal saline.
abstract: Normal saline (NS) is not used for trauma resuscitation because of its potential for acidosis. Lactated Ringer's (LR) is preferred instead. However, the two crystalloids have never been compared in trauma patients. We hypothesized that NS would be an acceptable fluid for resuscitation in the trauma patient. In 2011, a Level I trauma center switched resuscitation fluid from LR to NS. Admissions before and after the change were retrospectively reviewed. Demographics, vitals, blood work, and fluid intake were recorded over 24 hours. Acidosis level, stratified by Injury Severity Score (ISS), was compared. Four hundred ten patients were included, 207 in the LR cohort and 203 in the NS. Chloride (LR 105.26 ± 4.75 vs NS 106.48 ± 4.19), base excess (-2.53 ± 3.77 vs -3.28 ± 4.15), pH (7.37 ± 0.08 vs 7.36 ± 0.07), and bicarbonate (22.83 ± 3.45 vs 21.65 ± 5.06) were statistically different but not clinically significant. This was also true when results were stratified by ISS. In addition, there was no difference in the number of blood gases drawn between the groups (584 vs 544, P = nonsignificant). NS resuscitation is a safe, viable alternative to LR in the trauma population studied. Its use carries a potentially substantial cost savings on a national level.
authors.affiliation: Division of Trauma and Critical Care, Jackson Memorial Hospital/University of Miami Burn Center, Miller School of Medicine University of Miami, Miami, Florida, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Davis
authors.forename: Salman
authors.initials: S
authors.lastname: Alsafran
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Richie
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Moore
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
mesh_terms: D000328:Adult; D001774:Blood Chemical Analysis; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D018570:Risk Assessment; D012965:Sodium Chloride / Q000627:therapeutic use*; D015996:Survival Rate
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride