Trial reportChest2021
Effect of Early Balanced Crystalloids Before ICU Admission on Sepsis Outcomes.
Trial report in Chest, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Fluid resuscitation in adults with severe infection and sepsis: a systematic review and network meta-analysis.Frontiers in medicine · 2025Pooled it
- Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential analysis.Acta anaesthesiologica Scandinavica · 2022Pooled it
- Impact of Balanced Crystalloids vs Saline by Resuscitation Strategy in Sepsis: A Secondary Analysis of the Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis Trial.CHEST critical care · 2026Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Article
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
- A cost effectiveness analysis of a quality improvement intervention to increase preferential balanced fluid prescribing.BMC health services research · 2024Article
- A balancing act: drifting away from the reflexive use of "ab"normal saline.Pediatric nephrology (Berlin, Germany) · 2024Review
- [Guideline-conform treatment of sepsis].Die Anaesthesiologie · 2024Review
- Determinants of fluid use and the association between volume of fluid used and effect of balanced solutions on mortality in critically ill patients: a secondary analysis of the BaSICS trial.Intensive care medicine · 2024Article
- Balanced solution versus saline in critically ill patients: a new piece to the puzzle!Intensive care medicine · 2024Article
- Pediatric perioperative fluid management.Korean journal of anesthesiology · 2023Article
- Fluid Resuscitation in Septic Patients.Cureus · 2023Review
- Fluids in the ICU: which is the right one?Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Review
- Did Balanced Crystalloids Really Decrease Mortality in Patients with Sepsis?American journal of respiratory and critical care medicine · 2023Article
- Major Publications in the Critical Care Pharmacotherapy Literature: 2021.Critical care explorations · 2022Review
- Intravenous fluid therapy in sepsis.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2022Review
- Advances in Sepsis Care.Clinics in chest medicine · 2022Review
- Guidelines for the appropriate choice of fluid therapy for resuscitation of critically ill patients.Internal and emergency medicine · 2022Article
- Back to BaSICS: Early Treatments Matter in Critical Illness.American journal of respiratory and critical care medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
backgroundStudies suggest that using balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) rather than saline (0.9% sodium chloride) may improve outcomes for patients with sepsis in the ED and ICU. RESEARCH QUESTION: What is the relative impact on sepsis outcomes of fluid composition during early resuscitation in the ED vs after ICU admission? STUDY DESIGN AND
methodsWe performed a secondary analysis of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) data set, examining medical ICU patients with a diagnosis of sepsis (n = 1,641). SMART was a cluster-crossover trial comparing balanced crystalloids vs saline among critically ill adults. During the first 7 months of SMART, fluid choice was controlled only in the ICU ("ICU-only period"). In the final 15 months, fluid choice was coordinated between the ED and ICU ("ED and ICU period"). We performed logistic regression modeling for 30-day in-hospital mortality with an interaction term between randomized group (balanced crystalloids vs saline) and study period (ICU-only period vs ED and ICU period).
resultsThree hundred and sixty-seven patients with sepsis were enrolled during the ICU-only period and 1,274 were enrolled during the ED and ICU period. Thirty-day in-hospital mortality occurred in 47 of 142 patients (33.1%) in the balanced crystalloid group vs 74 of 225 patients (32.9%) in the saline group during the ICU-only period (OR, 1.14; 95% CI, 0.70-1.88) and in 170 of 682 patients (24.9%) in the balanced crystalloid group vs 181 of 592 patients (30.6%) in the saline group in the ED and ICU period (OR, 0.68; 95% CI, 0.52-0.89) (P value for interaction, .07), consistent with a beneficial effect of balanced crystalloid primarily in the ED and ICU period.
interpretationAmong patients with sepsis, the effect of balanced crystalloids vs saline on mortality was greater among patients for whom fluid choice was controlled starting in the ED compared with starting in the ICU.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.