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Hidden Fluids in Plain Sight: Identifying Intravenous Medication Classes as Contributors to Intensive Care Unit Fluid

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Intravenous medications are a major source of fluid intake in the ICU, contributing over 40% of total fluids. Antibacterials were the largest contributors, highlighting targets for fluid stewardship.

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Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Nephrology

Background:

  • Fluid stewardship is crucial for optimizing patient outcomes in intensive care units (ICUs).
  • Intravenous (IV) medications, flushes, and blood products are significant contributors to 'hidden fluids' in ICUs.
  • The specific impact of IV medication classes on total fluid intake remains largely uncharacterized.

Purpose of the Study:

  • To characterize intravenous medication classes by their contribution to ICU fluid intake.
  • To identify specific medication classes as targets for fluid stewardship initiatives.
  • To analyze fluid contribution based on administration frequency and total volume infused.

Main Methods:

  • A multi-center, retrospective nested cohort study was conducted.
  • Patients admitted to medical or surgical ICUs between January 2017 and December 2018 were included.
  • The study analyzed IV medication volume and frequency over the first 3 ICU days.

Main Results:

  • IV medications accounted for 42% ± 29% of total fluid intake (2601 ± 2573 mL) in the first 3 ICU days.
  • Antibacterials represented the largest volume (968 ± 846 mL) and frequency (86%) of IV medication administration.
  • Other significant contributors included vitamins/minerals/electrolytes and pain/agitation/delirium agents.

Conclusions:

  • IV medications constitute a substantial portion of fluid intake in the ICU within the initial 3 days.
  • Antibacterials are primary contributors to fluid volume and administration frequency.
  • Fluid stewardship strategies targeting IV medications, such as formulation changes and de-escalation, are warranted.