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Hidden Obligatory Fluid Intake in Critical Care Patients.
Muhammad Umair Bashir1, Anan Tawil1, Vishnu R Mani1
11 Department of Surgery, Harlem Hospital Center, New York, NY, USA.
Journal of Intensive Care Medicine
|January 16, 2016
Summary
Unrecognized "hidden obligatory fluids" contribute significantly to intensive care unit (ICU) patient fluid intake, often exceeding 1 liter daily. Accounting for these hidden fluids is crucial for accurate fluid balance management in critical care.
Area of Science:
- Critical Care Medicine
- Fluid Balance Management
- Patient Hydration
Background:
- Intensive care unit (ICU) patients receive intravenous fluids, but other sources of fluid intake are often overlooked.
- These unrecognized fluid sources, termed "hidden obligatory fluids," can significantly impact a patient's total daily fluid balance.
Purpose of the Study:
- To quantify the volume of "hidden obligatory fluids" in ICU patients.
- To test the hypothesis that these fluids contribute substantially to daily fluid intake.
Main Methods:
- A retrospective review of medical records and nursing charts was conducted for 98 patients admitted to Harlem Hospital ICU for at least 24 hours.
- The study identified and measured various sources and volumes of fluids contributing to patient intake.
Main Results:
- The mean "hidden obligatory fluid" volume was substantial, with enteral feeds alone contributing significantly.
- Calculated mean hidden obligatory volume was 978 mL (SD: 904) and 1571 mL (SD: 1023), compared to discretionary fluids of 2821 mL (SD: 2367).
- Factors like pressor support and renal replacement therapy influenced obligatory fluid volumes.
Conclusions:
- "Hidden obligatory fluids" represent a major, often underestimated, component of fluid intake in critical care settings.
- Clinicians should consider up to 1.5 L of these fluids in daily assessments to effectively manage patient fluid balance.
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