Effect of Reduced Sodium Chloride in Fluid Creep and Maintenance Fluids in Critically Ill Adults: A Randomized Controlled Trial

What this Trial Is About

Researchers are evaluating two strategies for managing intravenous fluids in critically ill adults who need a prolonged stay in the intensive care unit (ICU). These patients often receive large amounts of fluids that may contain more salt (sodium and chloride) than the body requires, which can cause fluid buildup and delay recovery. This phase IV, randomized, double-blind trial compares standard salt-rich fluids to fluids with reduced sodium and chloride to see if limiting salt intake can improve patient outcomes during ICU care. Participants are randomly assigned to one of two groups. One group receives a sodium-chloride reduction strategy where medications and intravenous lines use glucose 5% solutions, and maintenance fluids contain low sodium chloride (NaCl 0.3% in glucose 3.3%). The other group receives usual care with normal saline (NaCl 0.9%) for fluid creep and PlasmaLyte as maintenance fluid. The study fluids are administered throughout the ICU stay or until unavailable, with fluid volumes decided by the treating physician. During the study, patients are closely monitored for survival and days free from life support such as ventilators or dialysis over 90 days. Researchers assess electrolyte imbalances, fluid balance, kidney function, time on mechanical ventilation, and lengths of ICU and hospital stay. A nested substudy involves detailed monitoring of sodium, chloride, and water handling through blood tests, urine collection, body weight, and bioimpedance. The trial aims to provide evidence on whether reducing sodium and chloride in these fluids improves recovery in critically ill adults.

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