.webp&w=384&q=75){kind=logo}
Loading, please wait...
Loading, please wait...
The SMART trial compared balanced crystalloids with 0.9% saline for intravenous fluid administration in more than 15,000 critically ill adults. The primary outcome was a composite of major adverse kidney events within 30 days, including death, new renal-replacement therapy or persistent renal dysfunction. The balanced-crystalloid strategy produced a modestly lower rate of this composite outcome than saline. The absolute difference was small, but the direction of effect was consistent with the biologic concern that high chloride exposure from saline may contribute to renal and acid-base abnormalities. SMART is clinically valuable because fluid choice is often repeated many times over an ICU admission; a small difference per litre can become meaningful when accumulated across large volumes and prolonged care. The trial does not mean that saline is universally harmful or that balanced solutions are mandatory in every circumstance. Rather, it supports considering balanced crystalloids as a default option when there is no specific reason to use saline. In patients at high risk of kidney injury, the cumulative chloride burden and total fluid exposure deserve particular attention. SMART also reinforces a broader critical-care message: seemingly simple supportive therapies can influence important outcomes when delivered at scale.
Read summarized clinical updates, watch expert medical content, and earn CME certifications right from your smartphone.
Open your smartphone camera to scan and install.
The SMART trial compared balanced crystalloids with 0.9% saline for intravenous fluid administration in more than 15,000 critically ill adults. The primary outcome was a composite of major adverse kidney events within 30 days, including death, new renal-replacement therapy or persistent renal dysfunction. The balanced-crystalloid strategy produced a modestly lower rate of this composite outcome than saline. The absolute difference was small, but the direction of effect was consistent with the biologic concern that high chloride exposure from saline may contribute to renal and acid-base abnormalities. SMART is clinically valuable because fluid choice is often repeated many times over an ICU admission; a small difference per litre can become meaningful when accumulated across large volumes and prolonged care. The trial does not mean that saline is universally harmful or that balanced solutions are mandatory in every circumstance. Rather, it supports considering balanced crystalloids as a default option when there is no specific reason to use saline. In patients at high risk of kidney injury, the cumulative chloride burden and total fluid exposure deserve particular attention. SMART also reinforces a broader critical-care message: seemingly simple supportive therapies can influence important outcomes when delivered at scale.
last month
A bioengineered oral nanozyme microsupplement converts pathological ROS into a protective polydopamine hydrogel shield. By curbing neutrophil extracellular traps and balancing T cells, this platform outperforms standard 5-ASA in preclinical colitis models, opening new paths for sustained remission.
5 days back
Recent research reveals that downregulating YAP1/TAZ-TEAD via Hippo signaling triggers spontaneous human trophoblast syncytialization in 3D cultures, illuminating placental biology and preeclampsia.
4 weeks back
Abdominal aortic aneurysm rupture remains a catastrophic vascular emergency. Groundbreaking research reveals that USP53 accelerates aneurysm progression by reprogramming smooth muscle cell metabolism toward aerobic glycolysis, highlighting a promising target beyond conventional diameter-based surveillance.
6 days back
A breakthrough study leverages natural language processing to accurately identify incident medication-related osteonecrosis of the jaw and track antiresorptive drug holidays from clinical narratives in electronic health records, advancing osteoporosis pharmacovigilance and dental safety.
6 days back
Recent research defines ferro-aging as a conserved iron-lipid axis driving organ decline across primates. Age-related iron dyshomeostasis stimulates ACSL4-mediated lipid peroxidation, promoting cellular senescence. Notably, vitamin C directly inhibits ACSL4, suppressing phospholipid oxidation and multi-organ decay.
6 days back
