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The PLUS randomised controlled trial compared Plasma-Lyte 148, a balanced multielectrolyte solution, with 0.9% saline in critically ill adults across 53 ICUs in Australia and New Zealand. The primary outcome was death within 90 days. Despite the theoretical advantages of balanced solutions in reducing chloride exposure, the trial found no significant difference in 90-day mortality. There was also no clear overall reduction in new renal-replacement therapy or creatinine increase. The clinical importance of PLUS is that it adds another large, rigorous data set to the fluid-composition debate. Together with SMART and BaSICS, it suggests that fluid selection should not be framed as a universal mortality intervention. Rather, clinicians should integrate fluid composition into a broader strategy that considers indication, dose, renal function, electrolyte balance and cumulative fluid burden. This is directly relevant to CritiCARE 2026 sessions on fluid controversies, renal dysfunction and personalised haemodynamic management. For HCPs, the practical lesson is to avoid unnecessary fluid administration in the first place and then select a solution appropriate to the clinical context. Balanced fluids remain reasonable in many settings, but evidence does not support claiming a universal survival advantage over saline.
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The PLUS randomised controlled trial compared Plasma-Lyte 148, a balanced multielectrolyte solution, with 0.9% saline in critically ill adults across 53 ICUs in Australia and New Zealand. The primary outcome was death within 90 days. Despite the theoretical advantages of balanced solutions in reducing chloride exposure, the trial found no significant difference in 90-day mortality. There was also no clear overall reduction in new renal-replacement therapy or creatinine increase. The clinical importance of PLUS is that it adds another large, rigorous data set to the fluid-composition debate. Together with SMART and BaSICS, it suggests that fluid selection should not be framed as a universal mortality intervention. Rather, clinicians should integrate fluid composition into a broader strategy that considers indication, dose, renal function, electrolyte balance and cumulative fluid burden. This is directly relevant to CritiCARE 2026 sessions on fluid controversies, renal dysfunction and personalised haemodynamic management. For HCPs, the practical lesson is to avoid unnecessary fluid administration in the first place and then select a solution appropriate to the clinical context. Balanced fluids remain reasonable in many settings, but evidence does not support claiming a universal survival advantage over saline.
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