Emergency Medicine Department, University of the Witwatersrand, South Africa.
Division of Critical Care, University of Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg South Africa.
Anaesthesiol Intensive Ther. 2022;54(1):56-61. doi: 10.5114/ait.2021.111343.
Intravenous fluid administration is a vital component in the resuscitation of critically ill patients. In recent years, there have been many studies to help guide which fluids should be used for resuscitation. Currently, it appears that the international trend is away from the use of colloids and unbalanced crystalloids and towards the use of balanced crystalloids. The aim of our study was to determine whether evolving international evidence has impacted resuscitative fluid practices in the Emergency Department (ED) and the Intensive Care Unit (ICU) in a tertiary hospital in South Africa.
The study design was two-fold: a cross-sectional physician survey and a retrospective longitudinal observational study of the pharmacy fluid purchase records from the combined ED and ICU.
Cross-sectional survey: in 2020 a doctor was 8.3 times more likely to choose a balanced crystalloid for resuscitation regardless of the clinical scenario over any other fluid (CI: 5.0-13.8). 55% of doctors surveyed agreed that their resuscitation fluid of choice had changed for a variety of reasons with the most popular reason cited as post-graduate education. Retrospective longitudinal observational study: throughout the study period, balanced crystalloids were the majority fluid purchased, although in ED lactated Ringers was the preferred balanced crystalloid and in ICU PlasmaLyte was preferred. Minimal colloids were purchased over the study period in declining amounts.
Doctors working in a tertiary hospital in South Africa are following the trend of current evidence by using a balanced crystalloid as their resuscitation fluid of choice.
静脉输液是危重病患者复苏的重要组成部分。近年来，有许多研究旨在帮助指导应该使用哪种液体进行复苏。目前，国际趋势似乎是从使用胶体和不平衡晶体转向使用平衡晶体。我们的研究旨在确定不断发展的国际证据是否影响了南非一家三级医院急诊科（ED）和重症监护病房（ICU）的复苏液体实践。
研究设计分为两部分：横断面医生调查和药房 ED 和 ICU 联合购买记录的回顾性纵向观察研究。
横断面调查：2020 年，医生选择平衡晶体进行复苏的可能性是非平衡晶体的 8.3 倍（CI：5.0-13.8），无论临床情况如何。55%的被调查医生表示，由于各种原因，他们选择的复苏液已经发生了变化，最受欢迎的原因是研究生教育。回顾性纵向观察研究：在整个研究期间，平衡晶体是购买的主要液体，尽管在 ED 中，乳酸林格氏液是首选的平衡晶体，而在 ICU 中，首选的是 PlasmaLyte。在研究期间，胶体的购买量很少，呈下降趋势。
在南非一家三级医院工作的医生正在使用平衡晶体作为他们复苏的首选液体，这符合当前证据的趋势。
