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Saline Versus Plasma-Lyte A in Initial Resuscitation of Trauma Patients: A Randomized Trial

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

doi: 10.1097/SLA.0b013e318295feba
Randomized Controlled Trials

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.)

Balanced crystalloid solutions may help correct posttraumatic metabolic acidosis better than 0.9% NaCl. In a randomized, double-blind, parallel-group trial involving 46 trauma patients, resuscitation with Plasma-Lyte A, rather than 0.9% NaCl, resulted in faster and more complete correction of the base deficit and improved arterial pH and serum chloride and magnesium homeostasis.

From the Department of Surgery, University of California, Davis Medical Center, Sacramento, CA.

Correspondence: Lynette A. Scherer, MD, Trauma Administration, Mercy San Juan Dignity Health, 6401 Coyle Avenue, Carmichael, CA 95608. Email: lynettescherer@outlook.com.

Disclosure: This was an investigator-initiated trial supported by Baxter Healthcare (Deerfield, IL). All study activity, including design, enrollment, outcome assessment, analysis, creation of the manuscript, and the decision to publish, was conducted solely by the investigators independent of the sponsor. The investigators maintain full control of all study-related data. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.