Vanderbilt University Medical Center is encouraging its medical providers to stop using saline as intravenous fluid therapy for most patients, a change provoked by two companion landmark studies that are anticipated to improve survival and decrease kidney complications.
Saline, used in medicine for more than a century, contains high concentrations of sodium chloride, which is similar to table salt. Vanderbilt researchers found that patients do better if, instead, they are given balanced fluids that closely resemble the liquid part of blood.
Using primarily balanced fluids should prevent death or severe kidney dysfunction for hundreds of Vanderbilt patients and tens of thousands of patients across the country each year. Because balanced fluids and saline are similar in cost, the finding of better patient outcomes with balanced fluids in two large trials has prompted a change in practice at Vanderbilt toward using primarily balanced fluids for intravenous fluid therapy.
The Vanderbilt research, published in the New England Journal of Medicine, examined more than 15,000 intensive care patients and more than 13,000 emergency department patients who were assigned to receive saline or balanced fluids if they required intravenous fluid.
In both studies, the incidence of serious kidney problems or death was about 1 percent lower in the balanced fluids group compared to the saline group.
The difference, while small for individual patients, is significant on a population level. Each year in the United States, millions of patients receive intravenous fluids.