PLUS Trial

NEJM

March 3, 2022

Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

What was the research question?

Does the use of balanced multielectrolyte solution (BMES) (intervention) reduce the risk of acute kidney injury or death (outcome) in critically ill patients (population) over in 0.9% sodium chloride solution (saline) (comparator)?


How did they do it?

  • A multicenter, open-label, randomized, controlled, with 1:1 randomization.

  • 5037 critically ill patients in 53 ICUs in New Zealand and Australia

  • Patients received either BMES or Saline

  • Outcome was difference in mortality rate (primary outcome) or the need of need of renal replacement therapy (secondary outcome).


What did they find?

  • The mortality rate was 21.8% in BMES group compared to 22.0% in the saline group with no statistical significance.

  • New renal-replacement therapy was initiated in 12.7% in the BMES group compared to 12.9% in the saline group without statistical significance. 

  • The mean maximum increase in serum creatinine level was not different between the two groups.


Any limitations?

  • The Majority of patients in BMES received medications in NS

  • Kidney injury measure was a secondary outcome measure

  • Fluids that were received outside the ICU were not tracked

  • Clinicians were allowed to exclude patients when they thought one of the solutions was better!


What does it mean?

No difference in mortality rate or the need for renal replacement therapy between crystalloid fluid and saline in critically ill patients within the limitations of this trial.

PLUS Trial