Improving survival for the critically ill

February 2017

Research and intensive care specialist Dr Paul Young, winner of the 2016 HRC Liley medal. Photo: MRINZ

Late last year, research and intensive care specialist Dr Paul Young from the Medical Research Institute of New Zealand (MRINZ) received the Health Research Council Liley Medal for leading the HRC-funded SPLIT trial, the largest clinical trial ever conducted exclusively in New Zealand intensive care units (ICUs) and the highest impact study in the field of intensive care medicine for 2015.

The study, designed by Dr Young and other ICU doctors, was in response to data suggesting that saline solutions, which are cheaper than the Plasma Lyte alternative, may increase the risk of patients developing kidney failure compared with using Plasma Lyte.

Kidney failure, which can occur with acute illness, is associated with a high risk of death and often requires treatment with costly kidney dialysis.

The research showed that the two fluids had similar outcomes, and that using saline did not increase the risk of developing kidney failure. The study was published in the Journal of the American Medical Association (JAMA).

“The results are of major significance for global public health because they provide reassurance about the safety of intravenous saline, which is currently administered to more than a million patients around the world every day,” says Dr Young.

“Saline is also cheaper than the newer fluids like Plasma Lyte by between 50 cents and eight dollars, depending on the country, so this study also has the potential to lead to health care cost savings of millions of dollars every day on a global scale.”

Dr Young’s study, which was coordinated by MRINZ, involved 2,278 patients from four New Zealand ICUs. It was completed in 28 weeks of active recruitment at a cost of $200,000, given the millions of dollars it will save the global health care system it represents value for money.

“I’d like to acknowledge the help and support I’ve received on this study from ICU specialist colleagues from around the country, from the hundreds of ICU nurses who cared for the patients, to the ICU research coordinators who did the real work, and the MRINZ coordinating centre staff. Most of all, I’d like to thank all the patients who participated in the study.”

Dr Young is now extending his investigation into whether any one of the intravenous fluids compared to the other will improve survival rates for patients in intensive care. He is combining the extended trial with a similar one being run in Brazil, bringing the number of participants up to 19,000.

For more information about the research, please see http://www.mrinz.ac.nz/ICUProgramme.

To listen to Dr Young's interview with Radio New Zealand's Kim Hill on 25 February, please click play below: