A review of adult resuscitative fluid purchasing and usage trends at an academic tertiary hospital in Johannesburg

Abstract

Intravenous fluid administration is a vital compo nent in the resuscitation of critically ill patients [1]. Previously the clinical practice guiding the choice of fluid used in resuscitation has been predominantly governed by the opinion of the treating physician [2]. However, over the past decade there have been a va riety of publications on this matter that can assist in guiding the treating physician [3][4][5][6]. In 2012, two landmark studies were published against the use of hydroxyethyl starches (HES) [3,4]. The 6s study group found that when comparing resuscitation using HES versus resuscitation using acetated Rin gers in patients with severe sepsis, those who were resuscitated with HES had an increased risk of death and were more likely to require renal replacement therapy [3]. Similarly, the CHEST study group found that when comparing HES use versus saline in inten sive care patients, those resuscitated with HES were more likely to require renal replacement therapy [4].

Issuing of isotonic crystalloid solutions to Danish public hospitals in 2021—A retrospective nationwide observational study

“…Medical‐, surgical‐ and emergency departments primarily used saline over buffered solutions, while anaesthesiologic departments including ICUs primarily used buffered solutions. The latter is in line with a study by Jacobs et al assessing purchasing of isotonic crystalloid solutions in EDs and ICUs in Johannesburg, South Africa from 2015 to 2018 which found that buffered crystalloid solutions were the most used solutions 21 . Furthermore, the use of acetate (Plasmalyte) versus lactate (Ringers Lactate) buffered solutions was attributed to differences in departmental characteristics (emergency departments vs. ICUs) 21 .…”

“… 21 Furthermore, the use of acetate (Plasmalyte) versus lactate (Ringers Lactate) buffered solutions was attributed to differences in departmental characteristics (emergency departments vs. ICUs). 21 This contrasts with our data in which differences in the use of acetate‐ versus lactate‐buffered solutions were primarily at the regional level. The reason for the dominating use of saline across non‐anaesthesiological/ICU settings is unknown, however, as most of the recent larger trials conducted originate from anaesthesiological/ICU settings 22 , 23 , 24 , 25 a more pronounced translation of research findings into clinical practice in this setting seems likely.…”

“…The latter is in line with a study by Jacobs et al assessing purchasing of isotonic crystalloid solutions in EDs and ICUs in Johannesburg, South Africa from 2015 to 2018 which found that buffered crystalloid solutions were the most used solutions. 21 Furthermore, the use of acetate (Plasmalyte) versus lactate (Ringers Lactate) buffered solutions was attributed to differences in departmental characteristics (emergency departments vs. ICUs). 21 This contrasts with our data in which differences in the use of acetate‐ versus lactate‐buffered solutions were primarily at the regional level.…”

Fluid management of emergency department patients with sepsis—A survey of fluid resuscitation practices

“…This is in accordance with the findings in other surveys in emergency medicine, 15,27 although practice seems to be changing toward using more balanced fluids. 28 For the sites in the survey having…”

“…This is in accordance with the findings in other surveys in emergency medicine, 15 , 27 although practice seems to be changing toward using more balanced fluids. 28 For the sites in the survey having local regulations allowing nurses to administer a restricted amount of fluid, these only allowed for administration of normal saline, possibly affecting their response toward choosing normal saline over other fluids.…”