The Curbsiders Internal Medicine Podcast

#325 Hotcakes: Fluid Wars revisited, Sleep & Weight Loss, Vitamin D, Pneumonia and HBV Vaccine Updates

Mar 7, 2022
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INSIGHT

Balanced Fluids Didn’t Lower ICU Mortality

  • The PLUS trial found no mortality or renal benefit for plasmalyte versus normal saline in ICU patients.
  • The point estimate was near zero, so a large benefit is unlikely in this cohort.
INSIGHT

Crossover May Explain The Null Result

  • High crossover biased the PLUS trial toward the null because many in the plasmalyte arm received saline.
  • Differential contamination could mask a real benefit of balanced solutions if one exists.
ADVICE

Don’t Overreact To One Negative Trial

  • Continue favoring balanced electrolyte solutions when clinically appropriate despite PLUS being negative.
  • Use accumulated evidence and clinical judgment rather than one trial to change practice.
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