Discretionary Versus Routine Intravenous Fluids for Ambulatory Gastrointestinal Endoscopies: A Cohort Study Following...

Intravenous fluids (IVFs) are often routinely given to patients undergoing ambulatory gastrointestinal (GI) endoscopies, despite a lack of data to support this practice. A national IVF shortage occurred late 2024 after Hurricane Helene damaged a major manufacturing facility in the US. In response, our GI unit changed the IVF protocol from routine to discretionary administration to conserve fluid for those who needed it the most. This study examined the outcomes of this change.

This is a cohort study conducted at a tertiary referral hospital in the USA. We compared procedure data from two periods, October-November 2024 (discretionary or "as needed" fluid) and October-November 2023 (routine fluid). The primary outcome was the percentage of patients receiving vasopressors. Secondary outcomes included perioperative vital sign change (hypotension, tachycardia, desaturation), medication use (fluid, sedative, and other anesthesia administered agents), and anesthesia and recovery times.

A total of 1827 consecutive ambulatory esophagogastroduodenoscopies and colonoscopies were performed under monitored anesthesia care during the study period (983 discretionary IVF and 844 routine IVF). A higher percentage of the patients in the discretionary IVF cohort received vasopressors (18.1% vs. 12.8%, p < 0.01). There was no significant difference in perioperative hypotension (26.5% vs. 29.6%, p = 0.14), tachycardia or desaturation, or anesthesia or recovery time.

Discretionary vs. routine IVF administration for ambulatory GI endoscopies was associated with increased vasopressor use but not increased vital sign alteration or anesthesia or recovery time.