To the Editor A concern regarding the 0.9% Saline vs Plasma-Lyte 148 for ICU Fluid Therapy (SPLIT) trial is the use of normal saline as a ubiquitous diluent for medication delivery in critical care.1 It is not uncommon for patients who are critically ill to receive more than 1 L of normal saline daily from medications alone, not including fluids prescribed for resuscitation or other indications. This amount of normal saline has the potential to diminish the effect size if a difference existed between the normal saline and buffered crystalloid groups.
Flannery AH, Coz-Yataco AO. Acute Kidney Injury With Buffered Crystalloids vs Saline Among ICU Patients. JAMA. 2016;315(14):1519. doi:10.1001/jama.2016.0145