RCT comparing 0.9% saline with balanced crystalloids (LR or PlasmaLyte).
N=15,802 over 5 ICUs
Some big results: -Balanced crystalloids had fewer adverse kidney events (14.3%) compared to saline (15.4%) [OR 0.91, p=0.04] -Trend for new renal-replacement therapy was less for balanced crystalloid (2.5%) compared to NS (2.9) [p=0.8]
And the big kicker
- Overall 30-day in-hospital mortality was 10.3% in balanced crystalloids compared to 11.1% in the saline group [p=0.06] with NNT of 96!
Hey fellow medfag. I’ve tried making a few topics before, but they hardly get many replies. If we had a med general I know for sure I would check Veeky Forums more often.
I saw those papers in the newest NEJM, although I don’t care so much anymore since I’m going into psych. The conclusion I get from this is that crystalloids and saline are practically interchangeable. The different in outcomes is small and only a few are actually significant (with big p-values). This goes for both papers on the subject, and really, people who love crystalloids are going to swear by them and use them no matter what research says, so at least we know they are equal or maybe even marginally superior to saline.
Carson Ross
>Medical Professionals
you mean brainlet professional?
Medtards can't even integrate
James Jones
>significant >big p-values
Christopher Turner
IIRC Psych gets a couple inpatient rotations, so you can always impress your colleagues by recommending NS.
So, without getting to pedantic, all of the fluids studied in the paper are crystalloids. Normal Saline is a crystalloid.
Basically the argument goes: 1) If both crystalloids confer, essentially, the same benefit (volume resus-wise) 2) One crystalloid (LR) has a mild mortality and renal-protective benefit over another (NS) 3) Why would you use NS?
And the outcomes are significant...
I can't disagree with that! Math hard.
I think you know what he means.
Aaron Jones
I'm a sophomore at an Ivy League university and have a 2.9 GPA as a physics major. I already took the MCAT and received a 525. How fucked am I for Med School admissions?
I know people always say where you go to med school doesn't matter. but I want to go to a top-tier one. Is there still a remote chance of me doing so with my GPA? How can I improve my chances?
Wyatt Murphy
I hate the fact that society sees medfags as superior. When people ask what I do and I say I'm a math student they almost cringe. what the fuck.
Nicholas Davis
I'm not at all involved in application and far enough removed to not know what sort of MCAT score would be competitive. I would say that your GPA makes your chances rather slim.
What sort of extra-curriculars/research/connections do you have? What's your science GPA?
Charles Robinson
I don't see myself as superior to you, user. Math is incredibly rigorous and demanding. I value your work and fully recognize that we all stand on the shoulders of giants.
Medicine owes itself to biology/physiology/etc. Which, in turn owes itself to chemistry, physics, and fundamentally mathematics.
Thomas White
Having a P of .04 is still a 4% chance that it is due to random chance. Very unlike a p-value of 0.00001 for example, where it would be very hard to argue it is due to random chance.
Sat down and actually looked at the paper. All the significant ORs pass so closely to the null (CI for major kidney event was .82 to .99), and no change in mortality makes me feel there isn’t really a case to make here for balanced crystalloids. It looks like they had more renal-replacement therapy free days, but having literally the same median, mean, and SD is a very marginal benefit, if actually real and not a chance finding.
There was also no difference in mortality, icu stay, or even final creatinine ratio from baseline (which contradicts what was defined as a “major adverse kidney event”. It is likely only difference in renal replacement days contributed to that difference).
The paper didn’t even acknowledge how close to the null all these findings are and that strikes me as bad. The very high n leads to small CI, but that doesn’t mean those differences are clinically important.
