Intravenous fluid therapy in critically ill adults

Area of Science:

• Critical Care Medicine
• Nephrology
• Pharmacology

Background:

• Intravenous fluid therapy is a ubiquitous intervention for acutely ill patients, particularly in intensive care units (ICUs).
• Historical fluid administration practices, based on outdated theories, are increasingly challenged by current physiological understanding.
• Many intravenous fluids lack rigorous safety and efficacy evaluations, with some exhibiting significant toxicity.

Purpose of the Study:

• To critically evaluate the current practices of intravenous fluid therapy in critically ill patients.
• To examine the safety and efficacy of commonly used intravenous fluids.
• To explore the potential benefits of restrictive fluid strategies versus liberal fluid administration.

Main Methods:

• Review of existing high-quality, investigator-initiated studies on intravenous fluid therapy.
• Analysis of clinical data regarding fluid administration in ICUs and hospitalized patients.
• Comparative assessment of outcomes associated with liberal versus restrictive fluid strategies.

Main Results:

• Some intravenous fluids have demonstrated unacceptable toxicity, leading to market withdrawal.
• Liberal fluid administration, driven by concerns of hypovolemia, may contribute to fluid overload and organ injury.
• Emerging evidence suggests that restrictive fluid strategies may be associated with improved patient outcomes.

Conclusions:

• Current intravenous fluid therapy practices require re-evaluation based on contemporary evidence.
• The potential harm from fluid overload in critical illness necessitates a shift towards more judicious fluid management.
• Restrictive fluid strategies show promise for improving outcomes in critically ill patients.