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notably hydroxyethyl starch and other synthetic colloids, have unacceptable toxicity; as a result, several have been withdrawn from the market whereas others, controversially, are still in use.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 the first choice for a patient with acute brain injuries; albumin in a hypotonic carrier fluid is contraindicated for such patients. There is no role for hydroxyethyl starch solutions is acutely or critically ill patients and their continued use harms patients.
Critical Care Doctors
Experienced or advanced Critical Care Nurses
Upon completion of this activity, you should be able to:
1 November 2020
31 October 2023
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