A 55-year-old ICU patient post-Whipple procedure develops renal failure and requires fluid resuscitation. A randomised trial is cited to choose between normal saline and balanced crystalloid. Which trial demonstrated that balanced crystalloids (Lactated Ringer's or PlasmaLyte) reduced major adverse kidney events at 30 days compared to 0.9% saline in critically ill adults?
- A SMART trial ✓
- B CRISTAL trial
- C SAFE trial
- D SPLIT trial
Explanation
The SMART trial (Semler et al., NEJM 2018) was a pragmatic, unblinded, multiple-crossover trial in >15,000 ICU patients that showed balanced crystalloids (Lactated Ringer's or PlasmaLyte A) reduced the composite of 30-day MAKE (major adverse kidney events: death, new renal replacement therapy, persistent creatinine elevation ≥200%) compared to 0.9% saline (14.3% vs 15.4%, OR 0.90). The mortality benefit was primarily in septic patients. The CRISTAL trial compared crystalloids vs colloids overall. The SAFE trial evaluated albumin vs saline. The SPLIT trial showed no difference but was underpowered in lower-risk ICU patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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