Intravenous fluid therapy is one of the most common interventions in acutely ill patients. Each day, over 20% of patients in intensive care units (ICUs) receive intravenous fluid resuscitation and more than 30% receive fluid resuscitation during their first day in the ICU. Virtually all hospitalized patients receive intravenous fluid to maintain hydration and as diluents for drug administration. Until recently, the amount and type of fluids administered was based on a theory described over 100 years ago, much of which is inconsistent with current physiological data and emerging knowledge. Despite their widespread use, various fluids for intravenous administration entered clinical practice without a robust evaluation of their safety and efficacy. High-quality, investigator-initiated studies have revealed that some of these fluids, notably hydroxyethyl starch and other synthetic colloids, have unacceptable toxicity; as a result, several have been withdrawn from the market whereas others, controversially, are still in use. The belief that dehydration and hypovolaemia can cause or worsen kidney and other vital organ injury has resulted in liberal approaches to fluid therapy and the view that fluid overload and tissue oedema are ‘normal’ during critical illness; this is quite possibly harming patients. Increasing evidence indicates that restrictive fluid strategies might improve outcomes. For generic use a buffered salt solution such as Plasmalyte or Hartmanns (Lactated Ringers) is a safe first choice. In patients with septic shock not responding to crystalloid resuscitation, albumin is a rationale second choice. Although the evidence is less clear, normal saline should be first choice for patient with acute brain injuries; albumin in a hypotonic carrier fluid is contra-indicated for such patients. There is no role for hydroxyethyl starch solutions is acutely or critically ill patients and their continued use harms patients.
By the end of this lecture, the attendee will be able to:
- Understand current trends in fluid resuscitation practices around the world
- Understand current theory behind choice of fluids for critically ill patients
- Understand the harms associated with some available fluids
- Appreciate the body of evidence in favour of one fluid over another and the gaps in the evidence
This lecture is equal to 1 CE Contact Hour and 1 CPD Hour
Duration 1 hour(s).
Professor Simon Finfer
MBBS FRCP FRCA FCICM FAHMS MD
Simon Finfer is a Professorial Fellow in the Critical Care and Trauma Division at The George Institute for Global Health. He is a practicing critical care physician with an appointment as a Senior Staff Specialist at Royal North Shore Hospital and Director of Intensive Care at the Sydney Adventist Hospital, the largest not-for-profit hospital in New South Wales.
Simon is a Professor at the University of New South Wales, and a Clinical Professor at the University of Sydney. He is a past-Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. He chairs the Council of the International Sepsis Forum and is a member (Treasurer) of the Global Sepsis Alliance Executive. Simon is a member of the World Sepsis Day Steering Committee and recently co-chaired the 1st World Sepsis Congress, a two-day free online congress that attracted 14,000 registrants.
His postgraduate qualifications include Fellowships of the Royal Colleges of Physicians, the Royal College of Anaesthetists and the College of Intensive Care Medicine. He was elected to the ANZICS Honour Roll in 2011 and in 2012 he was awarded an honorary doctorate (Doctor of Medicine) by The Friedrich-Schiller University in Germany, an honour awarded once every 10 years. He is a Fellow of the Australian Academy of Health and Medical Sciences.
Simon’s major research interest is the design and conduct of large scale randomised controlled trials in critical care. Simon is active in forging major international research collaborations that have conducted large scale clinical trials and epidemiological research to improve the treatment of critically ill and injured patients. He has published over 150 peer-reviewed papers, many in the most prestigious journal in the world. He is frequently invited to lecture at major international conferences.
Simon is an Editor of The Oxford Textbook of Critical Care (2nd Ed.), the Critical Care Section Editor for The Oxford Textbook of Medicine (6th Ed.), and was a guest editor for The New England Journal of Medicine from 2012 - 2014.