Saline versus plasma-lyte A in initial resuscitation of trauma patients: A randomized trial

Jason B. Young, Garth H Utter, Carol R. Schermer, Joseph M Galante, Ho H Phan, Yifan Yang, Brock A. Anderson, Lynette A. Scherer

Research output: Contribution to journalArticle

115 Citations (Scopus)

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. Randomized controlled trial, level I. (ClinicalTrials.gov Record UCDIRB-200917793.

Original languageEnglish (US)
Pages (from-to)255-262
Number of pages8
JournalAnnals of Surgery
Volume259
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Resuscitation
Wounds and Injuries
Water-Electrolyte Balance
Confidence Intervals
Acidosis
Blood Pressure
Injury Severity Score
Hospital Mortality
Plasmalyte A
Serum
Intubation
Sodium Chloride
Blood Transfusion
Chlorides
Randomized Controlled Trials
Urine
Calcium
Acids
Mortality

Keywords

  • 0.9% sodium chloride
  • hyperchloremic acidosis
  • Plasma-Lyte A
  • resuscitation
  • trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Saline versus plasma-lyte A in initial resuscitation of trauma patients : A randomized trial. / Young, Jason B.; Utter, Garth H; Schermer, Carol R.; Galante, Joseph M; Phan, Ho H; Yang, Yifan; Anderson, Brock A.; Scherer, Lynette A.

In: Annals of Surgery, Vol. 259, No. 2, 02.2014, p. 255-262.

Research output: Contribution to journalArticle

Young, Jason B. ; Utter, Garth H ; Schermer, Carol R. ; Galante, Joseph M ; Phan, Ho H ; Yang, Yifan ; Anderson, Brock A. ; Scherer, Lynette A. / Saline versus plasma-lyte A in initial resuscitation of trauma patients : A randomized trial. In: Annals of Surgery. 2014 ; Vol. 259, No. 2. pp. 255-262.
@article{21e305bdef8d49a68180621673b30664,
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. Randomized controlled trial, level I. (ClinicalTrials.gov Record UCDIRB-200917793.",
keywords = "0.9{\%} sodium chloride, hyperchloremic acidosis, Plasma-Lyte A, resuscitation, trauma",
author = "Young, {Jason B.} and Utter, {Garth H} and Schermer, {Carol R.} and Galante, {Joseph M} and Phan, {Ho H} and Yifan Yang and Anderson, {Brock A.} and Scherer, {Lynette A.}",
year = "2014",
month = "2",
doi = "10.1097/SLA.0b013e318295feba",
language = "English (US)",
volume = "259",
pages = "255--262",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Saline versus plasma-lyte A in initial resuscitation of trauma patients

T2 - A randomized trial

AU - Young, Jason B.

AU - Utter, Garth H

AU - Schermer, Carol R.

AU - Galante, Joseph M

AU - Phan, Ho H

AU - Yang, Yifan

AU - Anderson, Brock A.

AU - Scherer, Lynette A.

PY - 2014/2

Y1 - 2014/2

N2 - 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. Randomized controlled trial, level I. (ClinicalTrials.gov Record UCDIRB-200917793.

AB - 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. Randomized controlled trial, level I. (ClinicalTrials.gov Record UCDIRB-200917793.

KW - 0.9% sodium chloride

KW - hyperchloremic acidosis

KW - Plasma-Lyte A

KW - resuscitation

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=84892907094&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892907094&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e318295feba

DO - 10.1097/SLA.0b013e318295feba

M3 - Article

AN - SCOPUS:84892907094

VL - 259

SP - 255

EP - 262

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -