The BASICS Trial

In this episode, we delve into the contentious subject of the benefits and drawbacks of using normal saline during resuscitation. We take a retrospective look at a number of studies and trials conducted on this subject over the years. The early trials pointed to an association between chloride-rich fluids like normal saline and increased renal failure and mortality, but these were often not randomized and potentially biased.

One of the major studies discussed was the Split trial, a randomized controlled trial that found no significant difference in renal failure, need for dialysis or mortality rates between patients given normal saline or plasmalyte. Another critical study, the SMART trial, caused much anticipation as it aimed to identify the harms of normal saline. However, this trial too showed no significant difference in Acute Kidney Injury (AKI), need for renal replacement cells or mortality.

A controversial aspect of the SMART trial was the use of a composite outcome called Make 30, a measure combining an increase in creatinine, need for dialysis and an increase in mortality. It was observed that there was a 1.1% absolute increase in the rate of Make 30 events in patients who received normal saline. However, questions have been raised about the reliability of such composite outcomes and their ability to mask random chance.

Finally, we discussed the BASICS trial, a randomized trial that compared balanced solutions and normal saline in critically ill patients. The findings paralleled the SMART trial, showing no significant difference in survival rates, renal failure, or need for dialysis.

In conclusion, despite early studies indicating potential harm from normal saline during resuscitation, large, well-executed studies like the BASICS and SMART trials have shown that the risk associated with normal saline is virtually non-existent. The discussion should now shift away from the type of fluid being administered to how much fluid and how it's being given. These factors are likely to have more significant implications on patient outcomes.