2. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Supported by the Vanderbilt Institute for Clinical and Translational Research through a Clinical and Translational Science Award (UL1 TR000445) from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences and by grants from the NIH National Institute of General Medical Sciences (K23GM110469, to Dr. Self), the NIH National Heart, Lung, and Blood Institute (HL08773809 and K12HL133117, to Dr. Semler; and R34HL105869, to Dr. Rice), the Vanderbilt Center for Kidney Disease (to Dr. Siew), and the Department of Veterans Affairs Health Services Research and Development Service (IIR 13-073, to Dr. Siew). Baseline creatinine values were calculated for 4666 patients (35.0%) who did not have an available measured value. ... Penninger, J. In a secondary per-protocol analysis, the population was limited to patients who received all fluids in accordance with the protocol. Serum Electrolyte Concentrations in the First 72 Hours after Arrival in the Emergency Department (ED). Valuable tools for building a rewarding career in health care. † Race was reported by patients or their surrogates and recorded in the electronic health record as a part of routine clinical care. 26. We hypothesized that balanced crystalloids would result in earlier hospital discharge and a lower incidence of major adverse kidney events than saline. Zampieri FG, Azevedo LCP, Corrêa TD, et al. Career Resources Editor’s Note: Social media has had a dramatic impact on the way the medical community communicates among its members and to the outside world. The trial included three key secondary outcomes: major adverse kidney events within 30 days, acute kidney injury of stage 2 or higher, and in-hospital death. Study protocol for the Balanced Solution versus Saline in Intensive Care Study (BaSICS): a factorial randomised trial. Let’s start with a clinical anecdote — rightfully considered the weakest form of evidence, yet paradoxically holding great power over us because we’re imperfect humans. This article has no abstract; the first 100 words appear below. N Engl J Med 2015;373:1350-1360. Am J Physiol 1989;256:F152-F157. The P values in the figure represent the overall difference between groups, calculated with the use of proportional-odds models. NEW! S5 in the Supplementary Appendix). The primary outcome was hospital-free days to day 28, a composite of in-hospital death and hospital length of stay defined as the number of days alive and out of the hospital between the index emergency department visit and 28 days later.20,25 Patients who died during the index hospitalization and those hospitalized for more than 28 days were classified as having zero hospital-free days. S4 in the Supplementary Appendix). Additional, exploratory outcomes are described in Table S2 in the Supplementary Appendix. (Certain details changed for privacy.) Scores range from −19 to 89, with higher scores indicating a profile of coexisting conditions that is more strongly associated with in-hospital death.24. Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU). Crit Care Med 2014;42(4):e270-e278. Patients in the balanced-crystalloids group had a lower incidence of major adverse kidney events within 30 days than those in the saline group (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P=0.01). During balanced-crystalloids months, clinicians had the option of choosing either lactated Ringer’s solution or Plasma-Lyte A. Clinicians and patients were aware of the treatment assignments. The type of crystalloid that was administered in the emergency department was assigned to each patient on the basis of calendar month, with the entire emergency department crossing over between balanced crystalloids and saline monthly during the 16-month trial. Patients with end-stage renal disease who were receiving long-term renal-replacement therapy at the time of ED arrival were not eligible for the outcome of acute kidney injury.
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