Fluid resuscitation in the critically ill: what is the next challenge?

Hammond, Naomi; Finfer, Simon

doi:10.5935/0103-507x.20150053

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…Based on our study findings and despite established changes in clinical practice, definitive randomised controlled trials comparing saline to buffered salt solutions are warranted to inform clinicians, regulators and policy makers on the relative efficacy and safety of these fluids. [ 30 ]…”

Section: Discussionmentioning

confidence: 99%

Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

et al. 2017

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BackgroundIn 2007, the Saline versus Albumin Fluid Evaluation—Translation of Research Into Practice Study (SAFE-TRIPS) reported that 0.9% sodium chloride (saline) and hydroxyethyl starch (HES) were the most commonly used resuscitation fluids in intensive care unit (ICU) patients. Evidence has emerged since 2007 that these fluids are associated with adverse patient-centred outcomes. Based on the published evidence since 2007, we sought to determine the current type of fluid resuscitation used in clinical practice and the predictors of fluid choice and determine whether these have changed between 2007 and 2014.MethodsIn 2014, an international, cross-sectional study was conducted (Fluid-TRIPS) to document current patterns of intravenous resuscitation fluid use and determine factors associated with fluid choice. We examined univariate and multivariate associations between patients and prescriber characteristics, geographical region and fluid type. Additionally, we report secular trends of resuscitation fluid use in a cohort of ICUs that participated in both the 2007 and 2014 studies. Regression analysis were conducted to determine changes in the administration of crystalloid or colloid between 2007 and 2014.FindingsIn 2014, a total of 426 ICUs in 27 countries participated. Over the 24 hour study day, 1456/6707 (21.7%) patients received resuscitation fluid during 2716 resuscitation episodes. Crystalloids were administered to 1227/1456 (84.3%) patients during 2208/2716 (81.3%) episodes and colloids to 394/1456 (27.1%) patients during 581/2716 (21.4%) episodes. In multivariate analyses, practice significantly varied between geographical regions. Additionally, patients with a traumatic brain injury were less likely to receive colloid when compared to patients with no trauma (adjusted OR 0.24; 95% CI 0.1 to 0.62; p = 0.003). Patients in the ICU for one or more days where more likely to receive colloid compared to patients in the ICU on their admission date (adjusted OR 1.75; 95% CI 1.27 to 2.41; p = <0.001).For secular trends in fluid resuscitation, 84 ICUs in 17 countries contributed data. In 2007, 527/1663 (31.7%) patients received fluid resuscitation during 1167 episodes compared to 491/1763 (27.9%) patients during 960 episodes in 2014. The use of crystalloids increased from 498/1167 (42.7%) in 2007 to 694/960 (72.3%) in 2014 (odds ratio (OR) 3.75, 95% confidence interval (CI) 2.95 to 4.77; p = <0.001), primarily due to a significant increase in the use of buffered salt solutions. The use of colloids decreased from 724/1167 (62.0%) in 2007 to 297/960 (30.9%) in 2014 (OR 0.29, 95% CI 0.19 to 0.43; p = <0.001), primarily due to a decrease in the use of HES, but an overall increase in the use of albumin.ConclusionsClinical practices of intravenous fluid resuscitation have changed between 2007 and 2014. Geographical location remains a strong predictor of the type of fluid administered for fluid resuscitation. Overall, there is a preferential use of crystalloids, specifically buffered salt solutions, over colloids. There is...

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Section: Discussionmentioning

confidence: 99%

Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

et al. 2017

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“…However, there is no clear guideline regarding intravenous infusion for resuscitation [4] but albumin solution is the first choice of the surgeon as plasma expander before or after cardiac surgery in critically ill patients [5]. However, albumin solutions have a high cost [6], chances of anaphylactoid reactions, and transmission of allergens, anticoagulants, and microorganisms [7]. In short, use of albumin solutions in critical conditions as resuscitation is controversial [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of albumin administration on post-operation mortality, duration on ventilator, and hospital stay on patients in cardiac intensive care: An observational study

Zhang¹,

Dai²,

Qi³

et al. 2021

Trop. J. Pharm Res

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Purpose: To justify the use of albumin infusion in patients in post-surgery cardiac intensive care unit. Methods: All patients who were hemodynamically stable before the operation and admitted into the surgical intensive care unit following coronary artery bypass, cardiopulmonary bypass, or aortic surgery, had no excessive postoperative bleeding and not on diuretic treatment, were included in the analysis. A total of 1998 patients were divided into two cohorts, viz, the first group was placed on albumin infusion (n = 999) while the second group received normal saline infusion (n = 999). Data were obtained from DICOM files of patients and records of pharmacy. Wilcoxon test or two-tailed paired t-test followed by Tukey post-hoc tests were performed for statistical analysis at 95 % of confidence level. Results: Albumin and normal saline administration did not decrease the duration of mechanical ventilation, incidence of mechanical ventilation, need for blood transfusion, and length of hospital stay (p > 0.05). Albumin infusion decreased the need for fresh frozen plasma transfusion from 85 to 67, reduced mortality (p = 0.0005, q = 3.959), lowered serum lactate level (p < 0.0001, q = 43.853), but increased cardiac index (p < 0.0001, q = 12.192) as well as financial burden (p < 0.0001, q = 95.158) for the patients, compared to normal saline group. Conclusion: In view of the foregoing, it is recommended that the use of restriction of albumin resuscitation in surgical intensive care unit should be restricted in this subset of patients evluated in this study.

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The Plasma-Lyte 148 v Saline (PLUS) study protocol: a multicentre, randomised controlled trial of the effect of intensive care fluid therapy on mortality

Hammond,

Bellomo,

Gallagher

et al. 2017

Critical Care and Resuscitation

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Fluid resuscitation in the critically ill: what is the next challenge?

Cited by 3 publications

References 17 publications

Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

Effect of albumin administration on post-operation mortality, duration on ventilator, and hospital stay on patients in cardiac intensive care: An observational study

The Plasma-Lyte 148 v Saline (PLUS) study protocol: a multicentre, randomised controlled trial of the effect of intensive care fluid therapy on mortality

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