The following is a summary of “Balanced Solution Versus Normal Saline in Predicted Severe Acute Pancreatitis: A Stepped Wedge Cluster Randomized Trial,” published in the January 2025 issue of Surgery by Ke et al.
Isotonic crystalloids are recommended for initial fluid therapy in acute pancreatitis, but the clinical benefit of using balanced multielectrolyte solutions (BMES) instead of normal saline (NS) remains unclear.
Researchers conducted a prospective study to compare the effect of BMES vs. NS on clinical outcomes in individuals with predicted severe acute pancreatitis (pSAP).
They conducted a stepped-wedge, cluster-randomized trial, enrolling individuals with pSAP [acute physiology and chronic health evaluation (APACHE) II score ≥8 and C-reactive protein (CRP) >150 mg/L] within 72 hours of symptom onset. The trial randomly assigned 11 study sites to staggered start dates for a crossover from NS to BMES. The primary endpoint was serum chloride concentration on day 3, with secondary endpoints including clinical and laboratory measures.
The results showed that individuals who received BMES had lower mean chloride levels on day 3 [101.8 mmol/L (SD: 4.8) vs. 105.8 mmol/L (SD: 5.9), difference -4.3 mmol/L (95% CI: -5.6 to -3.0 mmol/L); P<0.001]. Secondary outcomes showed reduced systemic inflammatory response syndrome (SIRS) in the BMES group (17.0% vs. 29.3%, P=0.024) and more organ failure-free days [3.9 days (SD: 2.7) vs. 3.5 days (SD: 2.7), P<0.001]. Individuals also spent more time alive and out of the ICU [26.4 days (SD: 5.2) vs. 25.0 days (SD: 6.4), P=0.009] and hospital [19.8 days (SD: 6.1) vs. 16.3 days (SD: 7.2), P<0.001].
They concluded that BMES improved serum chloride levels and clinical outcomes compared to NS in individuals with pSAP.
