Houda Dardari, BCPS, PharmD, AAHIVP
Clinical Pharmacist
AdventHealth Orlando
Orlando
Disclosure information not submitted.
Ruel Garcia, MD
Dr. Ruel Garcia
AdventHealth Winter Park
Winter Park, Florida, United States
Disclosure information not submitted.
Brian Morini, PharmD, BCPS
Dr. Brian Morini
AdventHealth Winter Park
Winter Park, Florida, United States
Disclosure information not submitted.
Title: Addition of Lactated Ringers to Sepsis Order Set On Incidence of Renal Replacement Therapy
Introduction: There is evidence that normal saline is associated with increased mortality and kidney injury in critically ill patients due to high chloride content. In this pre-post, quasi-experimental study (n=38), lactated ringers was added as an option for the initial weight based crystalloid bolus in the sepsis order-set which already had normal saline as an option. Seven critical care units of a large healthcare system were included in this study beginning in May 2019.
Methods: Critically ill patients with septic shock admitted to the intensive care unit without end stage renal disease at baseline were included in the analysis. Following the updates to the order-set, 18 patients from the prospective period (August-June 2020) that met inclusion criteria and received lactated ringers were compared to a similar retrospective period cohort group (January – June 2019) of 20 critically ill patients who received standard normal saline. This implementation was deemed to be a quality improvement study and thus IRB exempt. The primary outcome was incidence of renal replacement therapy, and secondary outcomes included ICU length of stay, ventilator days, mortality at 28 days, and persistent renal dysfunction. Baseline demographics were collected.
Results: No significant difference was identified in the primary outcome between the normal saline and lactated ringers groups for incidence of renal replacement therapy: 10% (2/20) vs 5.5% (1/18), p=1.0. No significant differences were found in the following secondary outcomes between normal saline and lactated ringers cohort, respectively: ICU length of stay (5.3 days vs 5.3 days, p=0.99), ventilator days (1.3 days vs 1.7 days, p=0.70), mortality at 28 days (15% [3/20] vs. 11% [2/18], p=1.0), and persistent renal dysfunction (0% vs 0%, p=1.0).
Conclusion: There is some controversy about the optimal crystalloids to use in critically ill patients. This data may implicate that use of lactated ringers or isotonic saline in critically ill septic patients may result in similar renal and clinical outcomes. Further studies with larger sample sizes, adequate power and inclusion of other clinical outcomes are warranted.