Do balanced crystalloids versus saline decrease the risk of adverse outcome events in critically ill adults?

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Why is this study important?

Normal saline (NS: 0.9% sodium chloride) is the most commonly used intravenous fluid, however, it contains a supra-physiologic concentration of chloride and has been associated with renal and other adverse events. Balanced fluids, containing a lower concentration of chloride, such as Ringer’s Lactate, have been reported to reduce this risk, but the evidence has not been consistent and mostly based on observational studies. The objective of this trial was to determine if administering balanced crystalloids as compared to normal saline to critically ill patients reduced their risk of adverse outcomes.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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