A Crossover Trial of Hospital-Wide Lactated Ringer’s Solution versus Normal Saline
Methodology: 4/5
Usefulness: 3/5
Question and Methods: The authors evaluated whether a hospital-wide policy of lactated Ringer’s versus normal saline reduces death or readmission, using a pragmatic cluster-randomized crossover trial across seven hospitals.
Findings: Death or readmission at 90 days occurred in 20.3% with lactated Ringer’s versus 21.4% with saline (adjusted absolute difference −0.53%, 95% CI −1.85 to 0.79).
Limitations: The trial was underpowered due to early termination, used administrative data, and evaluated policy-level exposure with imperfect adherence, limiting detection of small or subgroup-specific effects.
Interpretation: Switching to lactated Ringer’s as a hospital-wide default appears safe but does not meaningfully reduce death or readmission, suggesting any population-level benefit is small.
