Normosol-R vs Lactated Ringers in the Critically Ill: A Randomized Trial

Summary

A single-center pragmatic cluster-randomized multiple-crossover study assigned 2,084 critically ill adults to Normosol-R or lactated Ringer's. Mean plasma bicarbonate through day 7 did not differ (difference -0.12 mmol/dL; 95% CI -0.61 to 0.36; P=.61). New kidney replacement therapy occurred in 6.0% versus 5.0% and 30-day death in 16.3% versus 16.0%, without established differences.

Why it matters

This does not support replacing lactated Ringer's with Normosol-R to improve outcomes in eligible critically ill adults. It compares two balanced crystalloids, not saline versus a balanced fluid.

Main findings

• Bicarbonate difference -0.12 mmol/dL (95% CI -0.61 to 0.36; P=.61).
• New kidney replacement therapy 6.0% versus 5.0%, difference 1.0% (95% CI -1.2% to 3.1%).
• 30-day mortality 16.3% versus 16.0%, difference 0.3% (95% CI -2.9% to 3.6%).
• Detailed adverse-event data not reported in the reviewed abstract.

Limitations

Single-center ICU trial with a biochemical primary endpoint; absence of significant differences does not prove equivalence. Primary abstract reviewed; linked open-access full text was not reviewed end-to-end.