Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium.
Intensive Care Med. 2018 Apr;44(4):409-417. doi: 10.1007/s00134-018-5147-3. Epub 2018 Mar 27.
Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes.
We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity.
Maintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308-1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5-31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9-3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids.
Inadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.
静脉输液治疗及其副作用、容量、钠和氯超负荷的研究几乎完全集中在复苏环境中。我们旨在量化 ICU 中的所有液体来源，并评估液体渗漏，即作为药物或电解质载体给予的隐藏和无意识的容量。
我们精确记录了在我们 45 张床位的三级 ICU 中，14654 名患者入住期间，每一种给予的液体来源的容量、钠和氯负担，并模拟了重要的战略液体选择对患者氯负担的影响。在脓毒症患者中，我们评估了不同液体来源对累积液体平衡的影响，这是发病率的一个既定标志物。
维持和替代液体占平均每日总液体量的 24.7%，远远超过复苏液体（6.5%），是钠和氯的最重要来源。液体渗漏占平均每日总液体量的 32.6%[中位数 645ml（IQR 308-1039ml）]。采用低渗维持策略可更有效地降低氯水平[每日氯负担差异 30.8mmol（95%CI 30.5-31.1）]，而不是平衡复苏策略[每日差异 3.0mmol（95%CI 2.9-3.1）]。在脓毒症患者中，非复苏液体对累积液体平衡的绝对影响大于复苏液体。
鉴于大量的液体渗漏，在开具维持液时应避免无意中每日增加容量、钠和氯的负荷。当采用等渗维持策略时，这一点尤为重要。
