{"doi":"10.1016/j.chest.2025.02.008","title":"Normosol-R vs Lactated Ringers in the Critically Ill","abstract":"<h3>Background</h3> Balanced crystalloid solutions may improve clinical outcomes compared with saline for some critically ill adults, but it is unclear whether differences in composition between balanced crystalloid solutions affect outcomes. <h3>Research Question</h3> Does the choice of balanced crystalloid solutions (Normosol-R vs lactated Ringers) impact acid-base status, organ function, or outcomes for critically ill adults? <h3>Study Design and Methods</h3> This pragmatic, cluster-randomized, multiple-crossover trial at an academic medical center in the United States compared the use of Normosol-R vs lactated Ringers among critically ill adults. The primary outcome was the plasma bicarbonate (HCO<sub>3</sub><sup>−</sup>) concentration between enrollment and 7 days. Secondary outcomes included receipt of kidney replacement therapy and death by day 30. <h3>Results</h3> Between June 1, 2018, and January 31, 2019, 2,084 patients were enrolled. The median age was 59 years, 1,006 patients (48.3%) were female, and the median Sequential Organ Failure Assessment score was 5 (interquartile range, 3-8). HCO<sub>3</sub><sup>−</sup> concentration between enrollment and 7 days did not differ between the Normosol-R and lactated Ringers groups (mean difference, −0.12 mmol/dL; 95% CI, −0.61 to 0.36; <i>P</i> = .61). A total of 58 patients (6.0%) in the Normosol-R group and 47 patients (5.0%) in the lactated Ringers group received new kidney replacement therapy (absolute risk difference, 1.0%; 95% CI, −1.2% to 3.1%). Death by day 30 occurred in 172 patients (16.3%) in the Normosol-R group and 164 patients (16.0%) in the lactated Ringers group (absolute risk difference, 0.3%; 95% CI, −2.9% to 3.6%). <h3>Interpretation</h3> Among critically ill adults, the use of Normosol-R for IV fluid therapy did not affect plasma HCO<sub>3</sub><sup>−</sup> concentrations or clinical outcomes compared with lactated Ringers. <h3>Clinical Trial Registration</h3> ClinicalTrials.gov; No.: NCT03537898; URL: www.clinicaltrials.gov","journal":"CHEST Journal","year":2025,"id":540378,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":1,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9552,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03537898"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":264398,"name":"Ryan M. Brown","orcid":"0000-0002-8778-026X","position":1,"is_corresponding":false},{"id":332908,"name":"Karen E. Jackson","orcid":null,"position":2,"is_corresponding":false},{"id":1028131,"name":"Li Wang","orcid":"0000-0003-1585-8846","position":3,"is_corresponding":false},{"id":264403,"name":"Joanna L. Stollings","orcid":"0000-0001-6792-1646","position":4,"is_corresponding":false},{"id":432458,"name":"Robert E. Freundlich","orcid":"0000-0002-0343-9823","position":5,"is_corresponding":false},{"id":654877,"name":"Jonathan P. Wanderer","orcid":"0000-0002-3119-6873","position":6,"is_corresponding":false},{"id":249668,"name":"Edward D. Siew","orcid":"0000-0003-1343-8784","position":7,"is_corresponding":false},{"id":15360,"name":"Gordon R. Bernard","orcid":"0000-0002-4721-3068","position":8,"is_corresponding":false},{"id":106002,"name":"Wesley H. Self","orcid":"0000-0002-9300-3045","position":9,"is_corresponding":false},{"id":865592,"name":"Jonathan D. Casey","orcid":"0000-0001-7188-4200","position":10,"is_corresponding":false},{"id":105997,"name":"Todd W. Rice","orcid":"0000-0002-7136-5408","position":11,"is_corresponding":false},{"id":264405,"name":"Matthew W. Semler","orcid":"0000-0002-7664-8263","position":12,"is_corresponding":false},{"id":1047337,"name":"Edward T. Qian","orcid":"0000-0002-1092-3533","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T02:52:38.861025Z","pmid":"39971001","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}