Normal Saline Solution and Lactated Ringer’s Solution Have a Similar Effect on Quality of Recovery: A Randomized Controlled Trial - 21/01/19
Abstract |
Study objective |
The purpose of this study is to test the hypothesis that balanced crystalloids improve quality of recovery more than normal saline solution (0.9% sodium chloride) in stable emergency department (ED) patients. Secondary outcomes measured differences in health care use.
Methods |
A single-site, participant- and evaluator-blinded, 2-arm parallel allocation (1:1), comparative effectiveness, randomized controlled trial allocated adults receiving intravenous fluids in the ED before discharge to receive 2 L of lactated Ringer’s solution or normal saline solution. The primary outcome was symptom scores measured by the validated Quality of Recovery–40 instrument (scores 40 to 200) 24 hours after enrollment. Secondary outcomes included subsequent health care use and medication compliance.
Results |
Participants (N=157) were enrolled and follow-up was analyzed for 94 (follow-up rate of 60%) with intention-to-treat methodology. There was no difference in postenrollment Quality of Recovery–40 scores between normal saline solution and lactated Ringer’s solution groups (mean difference 2.4; 95% confidence interval [CI] –6.8 to 11.6). Although preenrollment scores were higher in the lactated Ringer’s solution group (mean difference 10.5; 95% CI 1.9 to 19.0), adjusting for presurvey imbalances did not change the primary outcome (adjusted difference –3.9; 95% CI –12.9 to 5.2). There were no differences in return to ED (mean difference 7.5%; 95% CI –8.7% to 23.8%), prescriptions filled (mean difference 22.2%; 95% CI –3.3% to 47.6%), or seeking care from another provider (mean difference –2.0%; 95% CI –19.9% to 15.9%) at 7 days.
Conclusion |
Normal saline solution and lactated Ringer’s solution were associated with similar 24-hour recovery scores and 7-day health care use in stable ED patients. These results supplement those of recent trials by informing fluid choice for stable ED patients.
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| Please see page 161 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Allan B. Wolfson, MD |
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| Author contributions: All authors completed the initial literature search and critically reviewed the article. AF and NM completed participant consent and data collection and drafted the article. MBS, BAF, and NMM developed the study design. MBS conducted data analysis. NM takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. Research reported in this publication was supported by the University of Iowa Department of Emergency Medicine and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under award U54TR001356 and NIH training grant 5 T35 HL 7485-38. |
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| Trial registration number: NCT03133767 |
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| The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 73 - N° 2
P. 160-169 - febbraio 2019 Ritorno al numero
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