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The BaSICS randomised clinical trial compared a balanced crystalloid solution with 0.9% saline in critically ill adults. More than 5,000 patients across Brazilian ICUs were randomised, making the trial one of several major studies examining whether fluid composition influences kidney outcomes and survival. The trial did not show a mortality advantage for balanced solution over saline in the overall population. That finding is important because physiological concerns about chloride load and kidney injury do not automatically translate into a large survival effect in every critically ill patient. For clinicians, the study should be interpreted alongside other large fluid trials rather than in isolation. Patient characteristics, type of shock, renal function, cumulative fluid exposure and the indication for each fluid bolus all influence the risk-benefit balance. This fits CritiCARE's sessions on fluid management, shock, AKI and personalised resuscitation. The practical shift is away from asking “Which fluid is best?” as a standalone question and toward asking “Does this patient need fluid now, which fluid is appropriate, and how will I know when to stop?” BaSICS therefore supports a broader concept of fluid stewardship: fluid is a drug, and both composition and cumulative exposure deserve deliberate prescribing.
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The BaSICS randomised clinical trial compared a balanced crystalloid solution with 0.9% saline in critically ill adults. More than 5,000 patients across Brazilian ICUs were randomised, making the trial one of several major studies examining whether fluid composition influences kidney outcomes and survival. The trial did not show a mortality advantage for balanced solution over saline in the overall population. That finding is important because physiological concerns about chloride load and kidney injury do not automatically translate into a large survival effect in every critically ill patient. For clinicians, the study should be interpreted alongside other large fluid trials rather than in isolation. Patient characteristics, type of shock, renal function, cumulative fluid exposure and the indication for each fluid bolus all influence the risk-benefit balance. This fits CritiCARE's sessions on fluid management, shock, AKI and personalised resuscitation. The practical shift is away from asking “Which fluid is best?” as a standalone question and toward asking “Does this patient need fluid now, which fluid is appropriate, and how will I know when to stop?” BaSICS therefore supports a broader concept of fluid stewardship: fluid is a drug, and both composition and cumulative exposure deserve deliberate prescribing.
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