What's the Best Intravenous Fluid for Sickle Cell Vaso-Occlusive Crisis?

Vaso-occlusive episodes (VOEs) in patients with sickle cell disease (SCD) often are complicated by hypovolemia, and normal saline generally is the fluid of choice for initial volume resuscitation. However, the comparative effectiveness of other volume expanders, such as lactated Ringer's solution (LR), are unclear. In this observational study (using target trial emulation), researchers evaluated 55,000 U.S. adult patients (median age, 30) with SCD who were admitted for VOEs; patients received either intravenous LR (3500 patients) or normal saline on hospital day 1.

Patients who received LR had significantly more hospital-free days (by day 30) than did patients who received normal saline (mean difference, 0.4 days). Patients who received LR also had significantly shorter hospital stays and lower risk for 30-day readmission and more opioid-free days. No differences were noted in in-hospital mortality, organ support–free days, and blood transfusion–free days.