Effect of Intravenous Fluid Treatment with a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial

Importance: Intravenous fluids are used for almost all intensive care unit (ICU) patients. Clinical and laboratory studies have questioned whether specific fluid types result in improved outcomes, including mortality and acute kidney injury. Objective: To determine the effect of a balanced solution vs saline solution (0.9% sodium chloride) on 90-day survival in critically ill patients. Design, Setting, and Participants: Double-blind, factorial, randomized clinical trial conducted at 75 ICUs in Brazil. Patients who were admitted to the ICU with at least 1 risk factor for worse outcomes, who required at least 1 fluid expansion, and who were expected to remain in the ICU for more than 24 hours were randomized between May 29, 2017, and March 2, 2020; follow-up concluded on October 29, 2020. Patients were randomized to 2 different fluid types (a balanced solution vs saline solution reported in this article) and 2 different infusion rates (reported separately). Interventions: Patients were randomly assigned 1:1 to receive either a balanced solution (n = 5522) or 0.9% saline solution (n = 5530) for all intravenous fluids. Main Outcomes and Measures: The primary outcome was 90-day survival. Results: Among 11052 patients who were randomized, 10520 (95.2%) were available for the analysis (mean age, 61.1 [SD, 17] years; 44.2% were women). There was no significant interaction between the 2 interventions (fluid type and infusion speed; P =.98). Planned surgical admissions represented 48.4% of all patients. Of all the patients, 60.6% had hypotension or vasopressor use and 44.3% required mechanical ventilation at enrollment. Patients in both groups received a median of 1.5 L of fluid during the first day after enrollment. By day 90, 1381 of 5230 patients (26.4%) assigned to a balanced solution died vs 1439 of 5290 patients (27.2%) assigned to saline solution (adjusted hazard ratio, 0.97 [95% CI, 0.90-1.05]; P =.47). There were no unexpected treatment-related severe adverse events in either group. Conclusion and Relevance: Among critically ill patients requiring fluid challenges, use of a balanced solution compared with 0.9% saline solution did not significantly reduce 90-day mortality. The findings do not support the use of this balanced solution. Trial Registration: ClinicalTrials.gov Identifier: NCT02875873

Uma análise crítica da literatura sobre a oferta e a circulação de moeda metálica no Brasil nos séculos XVI e XVII

Este artigo examina os principais fatores determinantes da oferta e da circulação de moeda metálica no Brasil nos séculos XVI e XVII. O objetivo é contribuir para o debate, até hoje pouco explorado, sobre a escassez de moeda no Brasil colonial. O trabalho é dividido em seis seções, além da introdução e considerações finais. A primeira apresenta as principais características do sistema bimetálico então vigente em Portugal e de sua política de desvalorização da unidade de conta. A análise da oferta de moeda no Brasil é desenvolvida nas quatro seções seguintes, destacando o início do processo de monetização, os fluxos de entrada e saída de metais, os impactos da política de cunhagem metropolitana e os episódios de remarcação e cunhagem de moeda no Brasil. Os determinantes do entesouramento são discutidos a seguir. Uma última seção resume os argumentos apresentados ao longo do trabalho.This paper examines the main factors that determined the supply and circulation of metallic coins in Brazil in the sixteenth and seventeenth centuries. The objective is to contribute to the debate, often neglected, on the scarcity of money in colonial Brazil. The paper is divided into six parts, on top of the introduction and the concluding remarks. The first presents the main features of the then prevalent Portuguese monetary system, as well as its policy of debasement. The next four parts deal with the supply of metallic currency in Brazil analysing respectively the early stages of the process of monetization, the inflows and outflows of precious metals, the impacts of the policy of coinage adopted by the Portuguese Crown, and some episodes of marking and minting of coins in Brazil. This is followed by an analysis of hoarding. It concludes with a summary of the main arguments developed along the paper