Vascular Access Conversation - IVUPDATE Podcast from IVTEAM

"If tens or hundreds of thousands of deaths could be prevented every year at minimal added cost by simply using whichever of the two fluids results in even slightly better outcomes, what could be the argument against using the slightly better fluid?" Semler (2022).
IV fluid choice and mortality

Extract:

“Balanced crystalloids (like lactated Ringer) and saline are the two commonly available options for intravenous isotonic crystalloid infusion. Both have been used for over a century, are widely available, and cost approximately $1 per liter to manufacture. More than 30 million patients in the United States receive these fluids each year. Because treatment with these fluids is so ubiquitous, differences in outcomes that might seem small at the level of the individual equate to massive differences in patient outcomes at the level of the health care system and society. For example, a true 1% absolute difference in mortality between balanced crystalloids and saline would equate to at least 200 000 preventable deaths annually (more deaths than are caused by any disease in the United States except heart disease or cancer). A true 0.1% absolute difference would equate to at least 20 000 preventable deaths annually (similar to all deaths from influenza in the United States each year). If tens or hundreds of thousands of deaths could be prevented every year at minimal added cost by simply using whichever of the two fluids results in even slightly better outcomes, what could be the argument against using the slightly better fluid?”

Reference:

Semler MW. Intravenous Fluids-A Test Case for Learning Health Systems. JAMA Netw Open. 2022 May 2;5(5):e2210054. doi: 10.1001/jamanetworkopen.2022.10054. PMID: 35503223.