(1028) Evaluation of Plasmalyte Versus Lactated Ringer in SICU Trauma Patients as Fluid Resuscitation

Introduction: In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and have demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer’s (LR) has shown benefit over NS, plasma- lyte (PL) with a higher osmolarity and different electrolyte formulation is thought to be superior.

Methods: A retrospective observational cohort study over 37 months conducted at NYU Langone Hospital- Long Island. Inclusion criteria were hospitalization at NYULH-Long Island surgical intensive care unit (SICU), ≥18 years old and received either PL or LR. All PL administrations and every 5th LR administration were included. Primary outcome was SICU LOS, hospital LOS, and mortality. Secondary outcomes measured biomarker change from baseline. Statistical significance was assumed if p< 0.05 via analysis by comparison of baseline characteristics via Wilcoxon rank sum test (continuous) and Chi-square or Fisher’s Exact test (categorical). Change of biomarkers from baseline were compared between groups using Wilcoxon rank-sum test.

Results: There were 113 patients in the PL group and 113 in the LR group. The PL group had higher APACHE II scores (16 v 13, p =0.033) and were more likely ventilated (39.3% v 20.4%, p=0.002) compared to LR group. Hospital LOS (12.0 vs 8.0, p< 0.001) and SICU LOS (6.0 vs 3.0, p< 0.001) were significantly longer in PL group compared to LR group, respectively. However, there was no difference in in-hospital (5.3% vs 3.5% p=0.519) and SICU (9.7% vs 5.3%, p>0.208) mortality between PL and LR groups. Statistically significant change from baseline of serum magnesium (0.1 vs -0.3, p< 0.001) and serum calcium (0.1 vs 0, p=0.005) between PL and LR were observed. No other biomarker change from baseline was significant.

Conclusions: Overall, PL group was associated with longer hospital and SICU length of stay compared to LR group. There was no difference in hospital and SICU mortality between the two groups. The use of PL in a more decompensated clinical picture could be contributing to these unfavorable outcomes.