Choice of fluid in acute illness: what should be given? An international consensus.

Published

Journal Article (Review)

Fluid management during critical illness is a dynamic process that may be conceptualized as occurring in four phases: rescue, optimization, stabilization, and de-escalation (mobilization). The selection and administration of resuscitation fluids is one component of this complex physiological sequence directed at restoring depleted intravascular volume. Presently, the selection of i.v. fluid is usually dictated more by local practice patterns than by evidence. The debate on fluid choice has primarily focused on evaluating outcome differences between 'crystalloids vs colloids'. More recently, however, there is interest in examining outcome differences based on the chloride content of crystalloid solutions. New insights into the conventional Starling model of microvascular fluid exchange may explain that the efficacy of colloids in restoring and maintaining depleted intravascular volume is only moderately better than crystalloids. A number of investigator-initiated, high-quality, randomized controlled trials have demonstrated that modest improvements in short-term physiological endpoints with colloids have not translated into better patient-centred outcomes. In addition, there is substantial evidence that certain types of fluids may independently worsen patient-centred outcomes. These include hydroxyethyl starch and albumin solutions in selected patient populations. There is no evidence to support the use of other colloids. The use of balanced salt solutions in preference to 0.9% saline is supported by the absence of harm in large observational studies. However, there is no compelling randomized trial-based evidence demonstrating improved clinical outcomes with the use of balanced salt solutions compared with 0.9% saline at this time.

Full Text

Duke Authors

Cited Authors

  • Raghunathan, K; Murray, PT; Beattie, WS; Lobo, DN; Myburgh, J; Sladen, R; Kellum, JA; Mythen, MG; Shaw, AD; ADQI XII Investigators Group,

Published Date

  • November 2014

Published In

Volume / Issue

  • 113 / 5

Start / End Page

  • 772 - 783

PubMed ID

  • 25326478

Pubmed Central ID

  • 25326478

Electronic International Standard Serial Number (EISSN)

  • 1471-6771

Digital Object Identifier (DOI)

  • 10.1093/bja/aeu301

Language

  • eng

Conference Location

  • England