Saline use in ICU
NZ clinical trial results of major significance for global public health
A recent clinical trial has not found any safety concerns with using saline as fluid therapy for intensive care patients.
The clinical trial, involving more than 2200 New Zealand Intensive Care Unit (ICU) patients, was funded by the Health Research Council of New Zealand and has just been published in the prestigious Journal of the American Medical Association.
The study compared saline with a newer fluid called Plasma Lyte®, and demonstrated that the two fluids resulted in similar outcomes.
“The results are of major significance for global public health, because they provide reassurance about the safety of intravenous saline, which is currently administered to more than a million patients around the World every day. In particular, we have found that using saline did not increase the risk of developing kidney failure compared to using Plasma Lyte®”, said the lead researcher and Intensive Care Specialist, Dr Paul Young.
The study was conducted because previous data had suggested that saline solutions, which have been used in clinical medicine since the cholera epidemics of the 1830s, might increase the risk of developing kidney failure. There was also a lack of data from clinical trials demonstrating the safety of newer alternative fluids like Plasma Lyte.
The mortality rate of the patients included in the trial while they were in hospital was much lower than typically observed in intensive care units in other parts of the world.
“This relatively low mortality rate is partly because of the strong commitment in New Zealand Intensive Care Units to improving patient outcomes through research”, said Dr Young. “If patients get sick enough to need intensive care, New Zealand is one of the best countries in the world to be; their chances of surviving here are better than almost anywhere else in the world.”
Although the study showed no difference in the risk of dying with one fluid compared to the other, the possibility the sickest ICU patients with the highest risk of death might do better with one fluid or the other remains unanswered and is now a high priority for Dr Young and his team. “In the field of intensive care medicine, whether saline or Plasma Lyte® leads to a lower risk of death in the sickest ICU patients is now the big question that everyone wants answered and we are now working on a trial to answer that question”, said Dr Young.
The clinical trial was conducted entirely in New Zealand ICUs in Auckland, Wellington, and Christchurch. The trial was only possible because of the collaboration of ICU doctors and nurses in all three hospitals.
“This study shows the value of the collaborative culture we have in the NZ intensive care community and the passion that New Zealand intensive care doctors and nurses share for improving the outcomes for the sickest patients in the hospital”, said Dr Young.
For further information, please contact:
Dr Paul Young
Capital and Coast District Health Board
Email: paul.young@ccdhb.org.nz
or
Dr Shay McGuinness
Auckland District Health Board
Email: ShayMc@adhb.govt.nz