Trial reportIntensive care medicine2019
154 compared to 54 mmol per liter of sodium in intravenous maintenance fluid therapy for adult patients undergoing major thoracic surgery (TOPMAST): a single-center randomized controlled double-blind trial.
Trial report in Intensive care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07189091 (Effect of Reduced Sodium Chloride in Fluid Creep and Maintenance Fluids in Critically Ill Adults), which is not on this map. Cited by 27 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Reduced Sodium Chloride in Fluid Creep and Maintenance Fluids in Critically Ill Adults: A Randomized Controlled Trial
Who cites it
27 citing papers in PubMed, 51 citations in OpenAlex.
- Incidence of hyponatremia with different postoperative intravenous maintenance fluids: a single-center, prospective, randomized trial.Journal of anesthesia · 2026Trial
- Intraoperative isotonic balanced versus hypotonic crystalloids on postoperative sodium homeostasis in small children undergoing major neurosurgery: a randomized controlled trial.BMC pediatrics · 2025Trial
- Trial
- Hypertonic saline for fluid resuscitation in ICU patients post-cardiac surgery (HERACLES): a double-blind randomized controlled clinical trial.Intensive care medicine · 2020Trial
- Unnecessary fluid therapy in patients with shock: Five classic fluid pitfalls and five ways to do it better.Annals of intensive care · 2026Review
- Impact of fluid creep on volume and chloride load in critically ill adults: a prospective study on its prognostic significance and association with MAKE30.Renal failure · 2025Article
- Effects of different sodium concentrations in fluids on brain, lung, and kidney in experimental ischemic stroke.Scientific reports · 2025Article
- Unlocking new frontiers: DNA nanotechnology's impact on acute kidney injury diagnosis and treatment.Nanomedicine (London, England) · 2025Review
- Capillary Filtration of Plasma Is Accelerated During General Anesthesia: A Secondary Population Volume Kinetic Analysis.Journal of clinical pharmacology · 2025Article
- Perioperative fluid therapy in adults and children: a narrative review.Frontiers in medicine · 2025Review
- Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review.Annals of intensive care · 2024Review
- Comparison of Fluid Replacement with Sterofundin ISOJournal of clinical medicine · 2023Article
- New Insights into the Fluid Management in Patients with Septic Shock.Medicina (Kaunas, Lithuania) · 2023Review
- Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review.Annals of intensive care · 2022Review
- Introducing NICE guidelines for intravenous fluid therapy into a district general hospital.BMJ open quality · 2022Article
- Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults.Annals of intensive care · 2021Review
- The Surviving Sepsis Campaign: Fluid Resuscitation and Vasopressor Therapy Research Priorities in Adult Patients.Critical care medicine · 2021Article
- The surviving sepsis campaign: fluid resuscitation and vasopressor therapy research priorities in adult patients.Intensive care medicine experimental · 2021Review
- Crystalloid and Colloid Compositions and Their Impact.Frontiers in veterinary science · 2021Review
- Aiming for zero fluid accumulation: First, do no harm.Anaesthesiology intensive therapy · 2021Review
Corrections and comments
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Authors and funding
16 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo determine the effects of the sodium content of maintenance fluid therapy on cumulative fluid balance and electrolyte disorders.
methodsWe performed a randomized controlled trial of adults undergoing major thoracic surgery, randomly assigned (1:1) to receive maintenance fluids containing 154 mmol/L (Na154) or 54 mmol/L (Na54) of sodium from the start of surgery until their discharge from the ICU, the occurrence of a serious adverse event or the third postoperative day at the latest. Investigators, caregivers and patients were blinded to the treatment. Primary outcome was cumulative fluid balance. Electrolyte disturbances were assessed as secondary endpoints, different adverse events and physiological markers as safety and exploratory endpoints.
findingsWe randomly assigned 70 patients; primary outcome data were available for 33 and 34 patients in the Na54 and Na154 treatment arms, respectively. Estimated cumulative fluid balance at 72 h was 1369 mL (95% CI 601-2137) more positive in the Na154 arm (p < 0.001), despite comparable non-study fluid sources. Hyponatremia < 135 mmol/L was encountered in four patients (11.8%) under Na54 compared to none under Na154 (p = 0.04), but there was no significantly more hyponatremia < 130 mmol/L (1 versus 0; p = 0.31). There was more hyperchloremia > 109 mmol/L under Na154 (24/35 patients, 68.6%) than under Na54 (4/34 patients, 11.8%) (p < 0.001). The treating clinicians discontinued the study due to clinical or radiographic fluid overload in six patients receiving Na154 compared to one patient under Na54 (excess risk 14.2%; 95% CI - 0.2-30.4%, p = 0.05).
conclusionsIn adult surgical patients, sodium-rich maintenance solutions were associated with a more positive cumulative fluid balance and hyperchloremia; hypotonic fluids were associated with mild and asymptomatic hyponatremia.
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