Evidence map›Paper›PMID 42852446›Full record

ArticleCHEST critical care2026

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.

Akram Khan, Elizabeth Munroe, Seiji Koike, Olivia Krol, Ebaad Haq, Milad Karami Jouzestani, Raju Reddy, Abdul Ahad Khan, Nathan I Shapiro, Ivor S Douglas

Abstract read
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In one paragraph

Article in CHEST critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Akram KhanFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Elizabeth MunroeFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Seiji KoikeFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Olivia KrolFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Ebaad HaqFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Milad Karami JouzestaniFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Raju ReddyFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Abdul Ahad KhanFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Nathan I ShapiroFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.
Ivor S DouglasFrom the Oregon Health and Science University (A. K., S. K., O. K., and R. R.), the Legacy Emanuel Internal Medicine Residency (E. H.), Portland, OR; the University of Michigan (E. M.), Ann Arbor, MI; the Pacific Northwest University of Health Sciences (M. K. J.), Yakima, WA; the University of Arizona College of Medicine-Phoenix (A. A. K.), Banner University Medical Center, Phoenix, AZ; the Beth Israel Deaconess Medical Center (N. I. S.), Harvard Medical School, Boston, MA; and the Department of Medicine (I. S. D.), Westchester Medical Center/New York Medical College, Valhalla, NY.

Funding

Developing and Evaluating a Personalized Approach to Initial Fluid Resuscitation in Patients with Hospital-Onset SepsisK23HL177175 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Elizabeth Munroe · 2025 to 2026
$346k
NHLBI NIH HHS K23 HL177175NHLBI NIH HHS L30 HL170379
6 · The paper itself

Abstract

backgroundThe optimal crystalloid for sepsis resuscitation and whether choice should differ under restrictive vs liberal strategy remains uncertain. RESEARCH QUESTION: Do outcomes differ by fluid type within liberal vs restrictive resuscitation strategies? STUDY DESIGN AND

methodsWe performed a secondary analysis of the Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis study. Patients were categorized by the predominant crystalloid in the first 24 hours (> 80%; balanced crystalloids [BCs], normal saline [NS], or mixed) and were stratified by randomized resuscitation strategy (liberal vs restrictive). The primary outcome was death before discharge by day 90. Secondary outcomes included new renal replacement therapy (RRT), organ support-free days, and adverse events. Analysis used inverse probability weighting with covariate balancing and tested a fluid-type by strategy interaction.

resultsAmong 1,563 patients, 423 patients (27%) received BCs, 226 patients (15%) received NS, and 914 patients (58%) receiving mixed fluids. The association of fluid type with mortality varied by strategy (χ

interpretationOutcomes differed by fluid type and resuscitation strategy. In the liberal arm, BCs were associated with lower mortality than NS or mixed fluids; this was not seen with a restrictive strategy. Early sepsis resuscitation should consider both fluid composition and strategy.

Indexed as

crystalloid solutions/administration and dosagefluid therapy/methodsinfusionsintravenous/methodsrandomized controlled trials as topicrenal replacement therapysepsis/mortalitysepsis/therapysodium chloride/administration and dosagetreatment outcome

Identifiers

PMID42852446
PMCPMC13649335

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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.