Balanced Crystalloids vs Normal Saline in Trauma Resuscitation

Key Takeaways

• In trauma patients with TBI, normal saline was associated with lower mortality and more ventilator-free days than balanced crystalloids.
• In trauma patients without TBI, no significant difference was reported for mortality or ventilator-free days between the two fluid strategies.
• No significant difference was observed in AKI, need for RRT, or ICU stay.

A systematic review and meta-analysis found that mortality between balanced crystalloids and normal saline in trauma resuscitation differed by traumatic brain injury status.

Investigators asked whether balanced crystalloids might be preferred over normal saline for trauma resuscitation. Analyses were performed with RevMan 5.4.1, and six randomized trials involving 1,950 trauma patients were included.

Among patients with TBI, normal saline was associated with lower all-cause mortality than balanced crystalloids (OR 1.35; 95% CI 1.06 to 1.72; p = 0.02). Within the TBI subgroup, normal saline was also associated with more ventilator-free days than balanced crystalloids (MD -0.67 days; 95% CI -0.86 to -0.48; p < 0.00001).

Among trauma patients without TBI, no significant mortality difference was reported (OR 1.17; 95% CI 0.47 to 2.90; p = 0.74), and no significant ventilator-free-day difference was reported in that subgroup (MD 3.0 days; 95% CI -3.36 to 9.36; p = 0.36).

For other outcomes, no significant difference was observed in acute kidney injury incidence, need for renal replacement therapy, or ICU stay.

The authors concluded that, despite the TBI subgroup signal favoring normal saline, balanced crystalloids remained a safe and reasonable option for trauma resuscitation.