Hot topics in intensive Care 2015

(1) In the SPLIT trial, the effect of a buffered crystalloid fluid (balanced solution) versus 0.9% saline on renal complications in ICU patients was investigated. The hypothesis was that buffered solutions would reduce the risk of acute kidney injury. A double-blind, cluster randomised, double-crossover trial was conducted in four ICUs in New Zealand. This means that a collaborating centre used either one of the fluids for a period of seven weeks in all ICU patients during that period. After these seven weeks the crossover was made to the other type of fluid. Patients admitted during the buffered solutions period remained in that group. The total study duration was 28 weeks. Bags with fluids were coded A and B so that the treating team did not know what was administered. Any ICU patient requiring crystalloid infusions who did not need dialysis due to established renal injury or was admitted for palliative care was included. In total 2262 patients were included. In the buffered crystalloid group, 102 of 1067 patients (9.6%) developed acute kidney injury within 90 days after enrolment compared with 94 of 1025 patients (9.2%) in the saline group (absolute difference 0.4% [95% CI −2.1% to 2.9%]; relative risk, 1.04 [95% CI 0.80 to 1.36]; p=0.77). No difference was found in the need for renal replacement therapy or any of the other endpoints. Also, in the pre-defined subgroup analyses, no differences were seen between different ICUs, more or less severely ill (Apache II scores) patients or between patients with and without sepsis. The conclusion of this study was that the use of buffered crystalloid solutions did not reduce the risk of acute kidney injury in ICU patients.