The collection shows a strong consensus favoring balanced crystalloids over saline, with posts referencing specific studies such as the NEJM meta-analysis showing reduced kidney-related adverse events and discussions around the SMART trial, using words like 'game changer' and 'definitive,' which indicate enthusiasm. The tone and choice of words illustrate high engagement and perceived clinical significance, emphasizing the importance and potential impact of these findings on fluid management in critically ill patients.
AgreementModerate agreement
Most discussions support the findings that balanced crystalloids are beneficial over saline, citing studies like the NEJM meta-analysis and the SMART trial.
InterestHigh interest
Posts demonstrate high interest, referencing multiple trials and meta-analyses, and discussing clinical implications extensively.
EngagementHigh engagement
Numerous posts delve into study details, methodology, and clinical application, indicating deep engagement.
ImpactHigh impact
The discussions reflect significant clinical impact, highlighting potential changes in practice and improved patient outcomes based on the research.
Abstract in brief
This study compared balanced crystalloids and saline in critically ill adults and found that balanced crystalloids were associated with fewer major adverse kidney events within 30 days.
The primary outcome measured was a combined complication including death, new renal replacement therapy, or persistent kidney dysfunction, with balanced crystalloids showing a statistically significant benefit over saline.
Overall, the results suggest that balanced crystalloids may be a better choice for intravenous fluids in critically ill patients to reduce kidney-related complications and mortality.]
Nov 25, 2020 · 33 likes · 13 shares · 14,806 followersView post →
DK
Diego Ketamino
@DiegoEscarraman · X
Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis
Jan 20, 2022 · 26 likes · 7 shares · 11,995 followersView post →
CM
Casey Albin, MD
@caseyalbin · X
4/
Most intensivists agree there is nothing “normal” about 0.9% NS.
The SMART Trial (NEJM 2018) does NS might lead to more adverse renal events? https://t.co/l3E88ZLVDl
15K pts received resusc w/ 0.9%NS vs. Plasma-Lyte/LR.
EndPoint: death, renal replacement tx, Cr⬆️>200% b/l
May 12, 2021 · 21 likes · 2 shares · 22,303 followersView post →
NM
Nida Qadir, MD
@NidaQadirMD · X
What might explain the differences in findings compared to the SMART trial?
➡️Different balanced crystalloids - SMART used both lactated ringers & Plasma-Lyte
➡️Different patients - 48% surgical in BaSICS vs 21% in SMART
https://t.co/pF7Ou2qyMa
Aug 10, 2021 · 20 likes · 3 shares · 10,253 followersView post →
G
GASOC
@GASOC_2015 · X
Ideal Sunday morning:
☕️ 1 coffee
Dec 12, 2021 · 20 likes · 6 shares · 3,084 followersView post →
This video examines the ongoing debate between using balanced crystalloids and normal saline for critically ill patients, reviewing recent clinical trials and their findings on renal outcomes, mortality, and…
This video explains the differences between normal saline and lactated Ringers, their composition, pH, and clinical implications. It highlights that balanced crystalloids like Ringers may reduce kidney complications…
@MoMohmandMD @ClevelandClinic @OhioAcp @ACPIMPhysicians @whinnec SMART investigators: "balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline."
https://t.co/AGaEBLd4VJ
#ccfhm25
Sep 5, 2025 · 1 like · 14,301 followersView post →
AP
Ash Paul
@pash22 · X
"Estimated effect of using balanced crystalloids versus saline in critically ill adults ranges from a 9% relative reduction to a 1% relative increase in the risk of death, with a high probability that the average effect of using balanced crystalloids is to reduce mortality" via https://t.co/flV6d8epUI
Jun 17, 2025 · 2 likes · 32,303 followersView post →
S
SadCrit
@schistosomnia.bsky.social · Bluesky
11. SMART
Balanced Crystalloids versus Saline in Critically Ill Adults
NEJM 2018
www.nejm.org/doi/full/10....
#emimcc
@germ_red @mjcolomina @rosalianavarro_ @montymythen @HansDonaldeBoer @DrMCecconi @JAMyburgh @Ron_George @AnaGimenoM @SWexner @TobyRichardsUCL @juanpcata @JuanVLlau @RafaelDalmau86 @OrlandoRPN @DiegoEscarraman @thomaswoodcock @Manu_Malbrain The effect of using balanced crystalloids versus saline in critically ill adults ranges from 9% reduction to a 1% increase in death, with a high % that the average effect of using balanced crystalloids is to reduce mortality
@NEJMEvidence @DogICUma
https://t.co/tHJ1nQvEa7
SMART trial showed pts randomized to balanced soln vs NS had lower 30-day all cause death or new RRT (https://t.co/vbIDRvhNUG). But the BaSICS trial did not show decr 90-day mortality (https://t.co/SMeeQlyXhp). A 2022 review favored balanced soln (https://t.co/X6ZW68QMui)
Dec 8, 2022 · 2 likes · 1 share · 232 followersView post →
SG
Swarnalatha Guditi
@SwarnalathaGud2 · X
Balanced Crystalloids versus Saline in Critically Ill Adults | NEJM https://t.co/GXsABhSeRV @ASNath107 #HNFTE @HydNephForum @DrPSVali @siddhubmcri
Oct 28, 2022 · 1 like · 1,603 followersView post →
CC
Casey Cable
@crit_caring_MD · X
RT @niven_alex: https://t.co/BZqGBcux3r
Oct 19, 2022 · 1 share · 1,785 followersView post →
CC
Casey Cable
@crit_caring_MD · X
RT @niven_alex: Which fluid should you use? “If there’s a big difference, we should have seen it” https://t.co/f6eZcSnsYC
Oct 19, 2022 · 1 share · 1,785 followersView post →
AN
Alex Niven
@niven_alex · X
https://t.co/BZqGBcux3r
Oct 19, 2022 · 1 like · 1 share · 1,530 followersView post →
AN
Alex Niven
@niven_alex · X
Which fluid should you use? “If there’s a big difference, we should have seen it” https://t.co/f6eZcSnsYC
Oct 19, 2022 · 3 likes · 1 share · 1,530 followersView post →
Anyone familiar with SMARTLY? @emcrit @ What happened to patients who were on saline when the month changed and the unit switched to balance? I assume they then converted to balanced solutions? And in ITT analysis they were counted as saline? https://t.co/OsfQPSEXCZ https://t.co/hRg7PV3by2
We then applied the model to vitals data from patients randomized to balanced crystalloids vs saline in the SMART RCT (https://t.co/6DxxdDXh0m)
We found heterogeneity of treatment effect between subphenotype & treatment group in predicting 30 day mortality
(3) https://t.co/tW7DUtiF4x
Open Access UCL Research: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis https://t.co/64veGDkg9x
RT @mcmtextbook: Balanced crystalloids versus saline: what to use in critically ill adults? Dr James Douketis and Dr Bram Rochwerg answer t…
Jun 8, 2022 · 4 shares · 3,664 followersView post →
BR
Bram Rochwerg
@Bram_Rochwerg · X
RT @mcmtextbook: Balanced crystalloids versus saline: what to use in critically ill adults? Dr James Douketis and Dr Bram Rochwerg answer t…
Jun 8, 2022 · 4 shares · 3,096 followersView post →
MM
McMaster Textbook of Internal Medicine
@mcmtextbook · X
Balanced crystalloids versus saline: what to use in critically ill adults? Dr James Douketis and Dr Bram Rochwerg answer the question in the latest #McMasterPerspective:
https://t.co/FOGNaNYsud
#criticalcare #medtwitter #MedEd #FOAMed https://t.co/Fs7DzdoTIj
Jun 8, 2022 · 10 likes · 4 shares · 1,317 followersView post →
M
Mamadasmedicas
@mamadasmedicas · X
Interesante la diferencia a nivel renal
N Engl J Med 2018;378:829-39.
DOI: 10.1056/NEJMoa1711584 https://t.co/6xUWPRLOD9
@tmorris_mrc @karlahemming I have a quick question:
Just found this RCT reporting "Both conditional (ICU-level) and marginal (population-level) effects [odds ratios] are reported." https://t.co/nf7tjOAzen
Do these conditional ORs only regard the ICUs included in this study? I didn't quite understand it
@phlegmfighter @PulmCrit @PulmCCM @msiuba That’s ridiculous. The SMART Trial even showed a benefit for the primary outcome for balanced crystalloids for the sepsis subgroup https://t.co/HGwU0byFoN https://t.co/kgYFkHsY02
May 11, 2022 · 16 likes · 1,736 followersView post →
S
SystematicReviewBot
@EvidenceRobot · X
RT @wuchanhsu: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:…
Join @NEJMres360 and the @etsu IM Residency Program as they discuss the NEJM Evidence article, “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” by @NaomiHammond et al. @GeorgeInstitute #JournalClub #ClinicalTrials https://t.co/dY9xFcAmDR
Mar 5, 2022 · 6 likes · 5 shares · 30,993 followersView post →
AA
ATS_Assemblies
@ATS_Assemblies · X
Mar 2, 2022 · 2 likes · 5,015 followersView post →
C
ChenShen
@ChenShe91720274 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
RT @ATSCritCare: What is the #evidence for balanced crystalloids vs #saline in #critically Ill adults?
@ATSCritCare Breathe Easy asked @an…
Mar 1, 2022 · 4 shares · 2,478 followersView post →
CM
Chris Carroll MD
@ChrisCarrollMD · X
RT @ATSCritCare: What is the #evidence for balanced crystalloids vs #saline in #critically Ill adults?
@ATSCritCare Breathe Easy asked @an…
Mar 1, 2022 · 4 shares · 20,137 followersView post →
AC
ATS Crit Care
@ATSCritCare · X
What is the #evidence for balanced crystalloids vs #saline in #critically Ill adults?
@ATSCritCare Breathe Easy asked @anzicsctg Simon Finfer about @NEJMEvidence article. Which #crystalloid is best? ⚖️
Mar 1, 2022 · 6 likes · 4 shares · 13,934 followersView post →
H
Higinio
@curabellas · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 25, 2022 · 30 shares · 1,056 followersView post →
N
npeducator
@lacjunkbox · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 22, 2022 · 30 shares · 42 followersView post →
AC
Alex Halstead DNP, FNP-BC, CRNA
@alex_crna · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 22, 2022 · 30 shares · 154 followersView post →
RA
Rubén Silva Ames
@RubnSilvaAmes1 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 21, 2022 · 30 shares · 58 followersView post →
DG
Dr. Sue Gross
@DrSueGross · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 21, 2022 · 30 shares · 3,032 followersView post →
BN
BRIC-NBRC
@DBT_NBRC · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 4,795 followersView post →
A
AFOSA
@AFOSA_GT · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 69 followersView post →
RC
Rodrigo Nunes Cal
@CalZole · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 3,382 followersView post →
J
JFKnight
@JfkTGI · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 154 followersView post →
TH
The George Institute for Global Health
@georgeinstitute · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 18,789 followersView post →
T
tnwpalm
@tnwpalm · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 1,231 followersView post →
NF
Nunzio De Feo
@Prof_De_Feo · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 200 followersView post →
L
LECS
@LuisErnestoCol1 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 62 followersView post →
F
fghp
@david464 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 158 followersView post →
KC
Karen Chung
@karenchungmd · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 918 followersView post →
JR
javier rodriguez
@javier_rdgz · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 285 followersView post →
MD
Mª Dolores Díaz
@mdialop1 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 114 followersView post →
AT
Andrés Taborro
@MdTaborro · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 449 followersView post →
JC
Jihad M. Chow
@Jihad_7 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 71 followersView post →
PT
Pablo Angeles Tacchino
@pabloange · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 761 followersView post →
J
Jeff
@jepoymd_ · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 1,404 followersView post →
UL
UPrint, LLC
@UPrint3D · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 1,224 followersView post →
AM
Angel Mauri
@Maurinetti · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 67 followersView post →
ขอ
ขอฝันใฝ่ในฝันอันเหลือเชื่อ
@Chu0025 · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 1,116 followersView post →
N
NEJM
@NEJM · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 20, 2022 · 30 shares · 931,987 followersView post →
DA
Dr. Fahmi Aldhaheri
@nephro_man · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 19, 2022 · 30 shares · 579 followersView post →
VS
Vinod Sharma
@V9DPCCM · X
RT @NEJMEvidence: ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial)…
Feb 19, 2022 · 30 shares · 26 followersView post →
NE
NEJM Evidence
@NEJMEvidence · X
ICYMI Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial). @NaomiHammond @GeorgeInstitute #CriticalCare #ClinicalTrials https://t.co/0QbRq4wxQ8 https://t.co/Or93Gzdmt8
Feb 19, 2022 · 78 likes · 30 shares · 30,993 followersView post →
SM
shari brosnahan, md,ms
@ShariBrosnahan · X
RT @NYULangonePCCSM: This week 2nd-year fellow Talha gave us a summary of balanced crystalloids vs saline in the ICU. Read more
Feb 18, 2022 · 2 shares · 581 followersView post →
N
NYULangonePCCSM
@NYULangonePCCSM · X
This week 2nd-year fellow Talha gave us a summary of balanced crystalloids vs saline in the ICU. Read more
Feb 18, 2022 · 2 likes · 2 shares · 2,363 followersView post →
VM
vnuttk.med
@vnuttk · X
RT @NEJMEvidence: Original Article: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (…
RT @HanCardiomd: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence
ht…
Feb 8, 2022 · 2 shares · 6,693 followersView post →
HH
Henry Han
@HanCardiomd · X
Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence
https://t.co/pH4y5lvhcp #ClinicalTrial #ClinicalPractice @NEJM @ICU_Management @robmentz @RyanTedfordMD @EduPOCUS @susannaprice @ShrillaB @lisneubeck https://t.co/F5NOzSpnn9
Feb 8, 2022 · 5 likes · 2 shares · 16,221 followersView post →
PF
Paulina Feola
@paulyhcm · X
RT @NEJMEvidence: “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” an Origi…
Feb 5, 2022 · 88 shares · 643 followersView post →
JP
Jamie Privratsky MD/PhD
@JamiePrivratsky · X
RT @kellumja: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:/…
Feb 2, 2022 · 12 shares · 836 followersView post →
JM
Juan Victor Lorente MD, PhD, MSc.
@jv_lorente · X
RT @kellumja: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:/…
Feb 1, 2022 · 12 shares · 668 followersView post →
LT
Landmark Trials
@LandmarkTrials · X
"The estimated effect of using balanced crystalloids versus saline in critically ill adults ranges from a 9% relative reduction to a 1% relative increase in the risk of death, with a high probability that the average effect of using balanced crystalloids is to reduce mortality."
RT @NEJMEvidence: “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” an Origi…
Jan 28, 2022 · 88 shares · 89 followersView post →
AB
Albert Bui
@RagingRenals · X
RT @kellumja: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:/…
Jan 27, 2022 · 12 shares · 441 followersView post →
SC
Swasti Chaturvedi
@SwastiThinks · X
RT @NEJMEvidence: Original Article: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (…
Jan 26, 2022 · 3 shares · 1,855 followersView post →
JS
Javier Sarrapio
@JSarrapio · X
RT @NEJMEvidence: “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” an Origi…
Jan 22, 2022 · 88 shares · 187 followersView post →
GM
Guillermo Méndez
@Memo99373405 · X
RT @DiegoEscarraman: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis
Jan 21, 2022 · 7 shares · 264 followersView post →
PY
Paul Young
@DogICUma · X
RT @WellingtonICU: Second, in the new NEJM Evidence, a meta-analysis by A/Prof @NaomiHammond et al: Balanced Crystalloids versus Saline in…
Jan 21, 2022 · 2 shares · 10,714 followersView post →
CP
Charlie Papini
@CarlosAPapini · X
RT @DiegoEscarraman: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis
Jan 21, 2022 · 7 shares · 386 followersView post →
GR
German Gomez Romero
@GermanGomez_ANR · X
RT @DiegoEscarraman: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis
Jan 21, 2022 · 7 shares · 522 followersView post →
A
amaya
@amaya_debg · X
RT @NEJMEvidence: “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” an Origi…
Jan 21, 2022 · 88 shares · 64 followersView post →
DF
Dana Fuhrman
@DanaFuhrman4 · X
RT @kellumja: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:/…
Jan 20, 2022 · 12 shares · 303 followersView post →
WI
Wellington ICU
@WellingtonICU · X
Second, in the new NEJM Evidence, a meta-analysis by A/Prof @NaomiHammond et al: Balanced Crystalloids versus Saline in Critically Ill Adults - A Systematic Review with Meta-Analysis, co-published to include the PLUS analysis: https://t.co/1PNp6FJXj3 https://t.co/R85h7JSWlg
Jan 20, 2022 · 8 likes · 2 shares · 3,453 followersView post →
IV
Ivan Villanueva
@Ivanvi_Castro · X
RT @DiegoEscarraman: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis
Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis
Jan 20, 2022 · 26 likes · 7 shares · 11,995 followersView post →
NE
NEJM Evidence
@NEJMEvidence · X
Original Article: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS trial). @NaomiHammond @GeorgeInstitute #CriticalCare #ClinicalTrials https://t.co/0QbRq4wxQ8 https://t.co/quMTVP4YCI
Jan 20, 2022 · 10 likes · 3 shares · 30,993 followersView post →
LM
Luca Molinari
@luca_moli90 · X
RT @kellumja: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:/…
Jan 20, 2022 · 12 shares · 20 followersView post →
DE
Dr Ernesto
@ernesdino1972 · X
RT @kellumja: Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https:/…
Jan 20, 2022 · 12 shares · 158 followersView post →
GK
George Kolostoumpis
@gkolost · X
RT @NEJMEvidence: “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” an Origi…
Jan 20, 2022 · 88 shares · 2,083 followersView post →
RT
Royal Flying Doctor Service SA/NT Aeromed Teams
@rfdsSANT_EGMMRS · X
RT @NEJMEvidence: “Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis (#PLUS),” an Origi…
Jan 20, 2022 · 88 shares · 1,364 followersView post →
KT
knut taxbro
@KTaxbro · X
The P-value is dead, wheras PlasmaLyte is not! Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence https://t.co/dyEhCZsSBr
RT @NidaQadirMD: What might explain the differences in findings compared to the SMART trial?
➡️Different balanced crystalloids - SMART used…
Aug 11, 2021 · 3 shares · 147 followersView post →
PP
pielegniarki.com.pl
@PielegniarkiP · X
RT @wszczeklik: Wyniki całkiem różne niż w badaniu SMART sprzed 3 lat
Aug 11, 2021 · 2 shares · 338 followersView post →
TT
Tomasz.Trapczyński
@TTrapczynski · X
RT @wszczeklik: Wyniki całkiem różne niż w badaniu SMART sprzed 3 lat
Aug 11, 2021 · 2 shares · 1,217 followersView post →
WS
Wojciech Szczeklik
@wszczeklik · X
Wyniki całkiem różne niż w badaniu SMART sprzed 3 lat
Aug 11, 2021 · 12 likes · 2 shares · 20,895 followersView post →
HM
Hasham Sarwar MD
@hashamsarwar · X
RT @NidaQadirMD: What might explain the differences in findings compared to the SMART trial?
➡️Different balanced crystalloids - SMART used…
Aug 11, 2021 · 3 shares · 1,370 followersView post →
AM
Alice Gallo, MD
@GallodeMoraesMD · X
RT @NidaQadirMD: What might explain the differences in findings compared to the SMART trial?
➡️Different balanced crystalloids - SMART used…
Aug 10, 2021 · 3 shares · 9,001 followersView post →
NM
Nida Qadir, MD
@NidaQadirMD · X
What might explain the differences in findings compared to the SMART trial?
➡️Different balanced crystalloids - SMART used both lactated ringers & Plasma-Lyte
➡️Different patients - 48% surgical in BaSICS vs 21% in SMART
https://t.co/pF7Ou2qyMa
Aug 10, 2021 · 20 likes · 3 shares · 10,253 followersView post →
MM
Matthew Borgman, MD
@MatthewBorgman1 · X
@nickmmark Seems like a pretty high mortality rate overall in that population. In the SMART trial the mort difference was 10 vs 11% https://t.co/HWVbUOnOe9
The SMART trial showed that balanced crystalloids resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. #SCCMSEChat
https://t.co/qKEBLXUYyO
Jun 24, 2021 · 2 likes · 1,000 followersView post →
L
Letaief
@hmidato · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 20, 2021 · 10 shares · 370 followersView post →
VT
Valentín Trujillo
@elvale_trujillo · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 18, 2021 · 10 shares · 112 followersView post →
AH
Abdelhamid Hamdy
@abdelhamed012 · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 17, 2021 · 10 shares · 3,540 followersView post →
RG
Roberto Gutiérrez
@DrRobertoGuti · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 17, 2021 · 10 shares · 784 followersView post →
DR
Dr Theepa N.M.R
@TNesam · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 17, 2021 · 10 shares · 698 followersView post →
AC
amber corrales
@Amber71253825 · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 17, 2021 · 10 shares · 17 followersView post →
DR
Delmy Rodríguez
@DelmyRodrguez3 · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 17, 2021 · 10 shares · 298 followersView post →
TS
Tired & Sakit
@tulunsokit · X
RT @edgarvlermamd: Balanced crystalloids vs saline in critically ill & non-critically ill adult patients from @NEJM #Nephpearls
#VisualA…
Jun 17, 2021 · 10 shares · 3,717 followersView post →
DM
Dr Moh
@Holistic__Medic · X
RT @caseyalbin: 4/
Most intensivists agree there is nothing “normal” about 0.9% NS.
The SMART Trial (NEJM 2018) does NS might lead to mor…
May 12, 2021 · 2 shares · 732 followersView post →
OS
Ofer Sadan
@neuro_intensive · X
RT @caseyalbin: 4/
Most intensivists agree there is nothing “normal” about 0.9% NS.
The SMART Trial (NEJM 2018) does NS might lead to mor…
May 12, 2021 · 2 shares · 231 followersView post →
CM
Casey Albin, MD
@caseyalbin · X
4/
Most intensivists agree there is nothing “normal” about 0.9% NS.
The SMART Trial (NEJM 2018) does NS might lead to more adverse renal events? https://t.co/l3E88ZLVDl
15K pts received resusc w/ 0.9%NS vs. Plasma-Lyte/LR.
EndPoint: death, renal replacement tx, Cr⬆️>200% b/l
May 12, 2021 · 21 likes · 2 shares · 22,303 followersView post →
PC
Priscilla M. De La Cruz
@priscillamdlc · X
@MarkFaberDO LR is my fave. It saves lives: https://t.co/7mcF8FAzXs
@LewyHughey @CharlesHallMD @Beska Lower rate of death from any cause, new renal-replacement therapy, or persistent renal dysfunction in the critically unwell:
https://t.co/ZrnBIrhjlL
@GharibSary @RosenelliEM @EMBoardBombs @thecurbsiders except for NS causing those pesky major adverse kidney events. Seems like an important concearn here. https://t.co/OsfQPSEXCZ
Feb 15, 2021 · 4 likes · 63,758 followersView post →
@yuanhypnosluo @nelsonSpinto Not unless you can control for cerebral edema. And if high chloride since this 2018, may need to know why. https://t.co/qISaWl0plm
Nov 25, 2020 · 33 likes · 13 shares · 14,806 followersView post →
A
AnneLenaS
@Sim_ALS · X
RT @avkwong: Number 6 SMART
#IFAD2020
https://t.co/It8wy5csgK
Nov 25, 2020 · 2 shares · 577 followersView post →
AW
Adrian Wong
@avkwong · X
Number 6 SMART
#IFAD2020
https://t.co/It8wy5csgK
Nov 25, 2020 · 1 like · 2 shares · 12,593 followersView post →
DE
David Ellison
@dhekidney · X
@medrants @hswapnil @UnremarkableLab @kidney_boy Regardless of mechanism, the recent recognition that balanced salt solutions may lead to better outcomes than saline raises possibility of clinical importance. https://t.co/9T3IxO0dYK
Nov 24, 2020 · 3 likes · 1,822 followersView post →
JH
Jen Readlynn, MD, FHM (she/her)
@jenreadlynn · X
And what about fluids for resuscitation?
-Balanced crystalloids (LR or Plasmalyte) >> Saline
-Reduced mortality
-Possibly reduced prolonged renal dysfunction
https://t.co/84vQNXNm2k. https://t.co/ARbUPyQ7iO
On the subject of minor mortality improvements from supportive care--
Lactated Ringer's solution produces slightly better kidney outcomes and lower mortality in ICU patients than 0.9% NaCl:
https://t.co/fZbEMoymB0
NEJM paper on RCT, N=15802:
https://t.co/22Xu4MwLG9
@figonoir @JannotMartin @fluidloading @PontEmmanuelle Il n’y a pas de logique physiologique à avoir peur du RL (le balancé le plus commun et le plus cheap) même et surtout en cas d’IRA et/ou d’hyperkaliemie, le NaCl fait pire. Un billet: https://t.co/F79AHFell0
, soutenu par qq articles anciens, et nouveaux: https://t.co/p5l6JDzB1c
@MDaware @OBGaYN @theblondeMD @YValtis just shared this study that shows the NNT for improved mortality in severe sepsis is 25. That’s very clinically significant (in addition to statistically significant)
https://t.co/yKnOaKbRYz
@NephroGuy @Uriel_Skater @VeraZertucheMD @ArgaizR @GotesJose https://t.co/pLagwMacXC
Opino que la cantidad importa y en CAD se usan grandes cantidades https://t.co/Tx0pWN2Cix
Apr 24, 2020 · 1 like · 2,617 followersView post →
GS
Gurmeet Singh
@gurm33t · X
Be #SMART https://t.co/qkS7Ve49G8 Listen to @andyshaw007 https://t.co/aRJ9PzuNXl
Mar 2, 2020 · 3 shares · 2,548 followersView post →
EF
Ed Mariano, MD, MAS, FASA, FASRA
@EMARIANOMD · X
@MacdonellSu @LGHhaiti @TrinaMonte @antonchau1 @Dolores_McKeen @drlauraduggan @AlanaFlex @DrRayTang @PeterRoseAnesth @ronmree At the #WAS2020 PACT West meeting, we discussed alternative study designs. Here is an example of a "pragmatic, unblinded, cluster-randomized, multiple-crossover trial" as mentioned by Dr. Jacobsohn https://t.co/NgmG0mkqaT @DrTimJen
Mar 2, 2020 · 8 likes · 3 shares · 23,587 followersView post →
MO
Metin Omerović
@Meto_EM · X
@EMS_gp @gregorprosen @MihaKodela @MetelkoMiha @kurincicj @SpelaBaznik Prvi liter obicajno FR, ker nimam izvidov. Zaradi visokega Na+ dober pri poskodbah glave in pravih hipovolemicnih hipoNa+. Ne verjamem, da z 1 L prispevam k hiperCl- acidozi.
Se strinjam, da je pri kriticno bolnih zgodnja uporaba balans.
Feb 17, 2020 · 2 likes · 1,081 followersView post →
JP
Jigna A. Patel
@JignaAmitPatel · X
A plethora of complications from over-resuscitation with saline.
@thebyrdlab Agreed, it would have to be pragmatic. You would never get consent from 10 thousand patients. Like the NS vs LR study out of Vanderbilt. But it took 15,000 patients for that.
https://t.co/XnvpQ3Sbl4
RT @Fluid_Academy: This definitive NEJM paper was the first to show higher major adverse kidney events with saline over balanced solutions…
Oct 26, 2019 · 8 shares · 6,033 followersView post →
SN
Syed Shahrul Naz
@drshahrul80 · X
RT @Fluid_Academy: This definitive NEJM paper was the first to show higher major adverse kidney events with saline over balanced solutions…
Oct 26, 2019 · 8 shares · 6,931 followersView post →
LN
Liliana Villamil-N
@lilivillamil · X
RT @Fluid_Academy: This definitive NEJM paper was the first to show higher major adverse kidney events with saline over balanced solutions…
Oct 26, 2019 · 8 shares · 108 followersView post →
MM
Manu Malbrain
@Manu_Malbrain · X
RT @Fluid_Academy: This definitive NEJM paper was the first to show higher major adverse kidney events with saline over balanced solutions…
Oct 26, 2019 · 8 shares · 10,282 followersView post →
AP
Anil Prasad
@Anil_Prasad1234 · X
RT @Fluid_Academy: This definitive NEJM paper was the first to show higher major adverse kidney events with saline over balanced solutions…
Oct 26, 2019 · 8 shares · 282 followersView post →
FA
Fluid Academy
@Fluid_Academy · X
This definitive NEJM paper was the first to show higher major adverse kidney events with saline over balanced solutions
https://t.co/8EQOaSTd6W
...with limitations - single centre study (though the recruitment was astronomical!)
#IFAD2019 #FOAMed #FOAMcc
Oct 26, 2019 · 15 likes · 8 shares · 18,836 followersView post →
BW
Bob Wachter
@Bob_Wachter · X
@LekshmiMD: while we've (internists, at least) always been taught to prefer normal saline, new study (Semler MW @NEJM 2018) supports use of balanced crystalloids over saline as go-to for fluid resuscitation in shock (pic) https://t.co/80nBDsysc7 #UCSFMHP2019 https://t.co/z2gf0hBWWu
Oct 17, 2019 · 2 likes · 241,035 followersView post →
The @PCCRG's SMART trial was a game changer: studying an almost ubiquitous intervention (crystalloid fluid administration) performed in critically ill adults for decades with minimal pre-existing data on patient-centered outcomes.
https://t.co/TlO1erkGO6
When people resist use of balanced solutions because of the presumed risk of hyperkalemia, how do they respond to the data from SMART showing no hyperkalemia signal at all?
https://www.nejm.org/doi/suppl/10.1056/NEJMoa1711584/suppl_file/nejmoa1711584_appendix.pdf
What study needs...
@CardiacJoshi @f2harrell Most UK EHR has a very long way to go for sure. But SMART trial from @toddrice_ICU is an example of how it could occur in practice:
https://t.co/PvQsniB4Mt
Discussion of 3 different pragmatic trials (PREVENT, SMART, SALT-ED) from @toddrice_ICU #CCC48 https://t.co/mjKL2i94Fw
https://t.co/SswzMkgXoE
https://t.co/034Jtc8JNJ
... 10.1056/nejmoa1711584. 7942 patients in the balanced-crystalloids group,; Balanced: 1139 (14.3%) versus Saline: 1211 of 7860 patients (15.4%) had a major ...
Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome ...
News
doi:10.1056/NEJMoa1711584. 11. Chua HR, Venkatesh B, Stachowski E, et al. Plasma-Lyte 148 vs 0.9% saline for fluid resuscitation in diabetic ketoacidosis. J ...
A review of adult resuscitative fluid purchasing and usage trends at ...
News
Balanced crystalloids ver- sus saline in critically ill adults. N Engl J Med 2018; 378: 829-839. doi: 10.1056/NEJMoa1711584. 7. Morgan TJ. The ideal crystalloid ...
NE
MA
DK
CM
NM
G
MH
AP
R
PP
TL
J
TR
PY
GM
J
ZS
SC
SG
CC
AN
JF
SB
S
UD
EE
T陳
MC
H
BR
MM
M
M
AA
GH
W
RD
KM
GK
JR
TC
AA
C
NR
NI
EF
CM
AC
H
N
AC
RA
DG
BN
A
RC
J
TH
T
NF
L
F
KC
JR
MD
AT
JC
PT
J
UL
AM
ขอ
N
DA
VS
SM
N
VM
D
HH
PF
JP
JM
LT
BD
AB
SC
JS
GM
CP
GR
A
DF
WI
IV
GE
A
LM
DE
RT
KT
AL
OS
A
GM
G
JG
WB
FR
AA
SM
UA
G
PP
TT
WS
HM
AM
MM
AS
L
SR
L
VT
AH
RG
DR
DR
TS
DM
PC
ソ
DA
DM
L
AN
SS
SN
TD
JW
A
AW
DE
JH
JL
D
JP
DM
D
S
I
R
FA
A
GS
CC
AD
TF
DF
EF
MO
JP
TM
RE
TW
T
NF
LN
MM
AP
FA
BW
CC
BM
DW
DM
EF
AC
SC
PG
ر
NM
WP
HM
SN
JC
MN
MS