Gamble Kelly C, Smith Susan E, Bland Christopher M, Sikora Newsome Andrea, Branan Trisha N, Hawkins William Anthony
University of Georgia, Savannah, GA, USA.
Ascension Seton PGY-1 Resident, Austin, TX, USA.
Hosp Pharm. 2022 Apr;57(2):230-236. doi: 10.1177/00185787211016339. Epub 2021 May 19.
Fluid stewardship targets optimal fluid management to improve patient outcomes. Intravenous (IV) medications, flushes, and blood products, collectively referred to as hidden fluids, contribute to fluid intake in the intensive care unit (ICU). The impact of specific IV medications on fluid intake is unknown. Characterize IV medication classes based on contribution to ICU fluid intake by frequency of administration and total volume infused to identify targets for fluid stewardship. This multi-center, retrospective nested cohort study included patients admitted to a medical or surgical ICU between January 2017 and December 2018. The primary outcome was to identify the volume contribution of specific IV medication classes administered over the first 3 ICU days. Secondary outcomes were the administration frequency of these medications and their proportion of total daily volume intake over the first 3 ICU days. The study included 210 patients. The largest mean administration volumes over the course of the first 3 ICU days were attributed to antibacterials (968 ± 846 mL), vitamins/minerals/electrolytes (416 ± 935 mL), pain/agitation/delirium agents (310 ± 512 mL), and vasoactive agents (282 ± 744 mL). The highest frequencies over the course of the first 3 ICU days were attributed to antibacterials (n = 180; 86%), pain/agitation/delirium agents (n = 143; 68%), vitamins/minerals/electrolytes (n = 123; 59%), and vasoactive agents (n = 96; 46%). IV medications contributed 2601 ± 2573 mL of fluid volume per patient over the first 3 ICU days, accounting for 42% ± 29% of overall volume. IV medications contribute over 40% of total fluid intake within the first 3 days of ICU admission, with antibacterials as top contributors by administration volume and frequency. Future research implementing fluid stewardship to ICU fluid sources, such as concentrating IV medications, switching IV medications to oral formulations, de-escalation of antibacterials, and reduction of maintenance fluids, should be performed to minimize hidden fluids from IV medications.
液体管理旨在实现最佳的液体管理，以改善患者预后。静脉内（IV）药物、冲洗液和血液制品，统称为隐性液体，是重症监护病房（ICU）液体摄入量的一部分。特定IV药物对液体摄入的影响尚不清楚。根据给药频率和输注总量对ICU液体摄入的贡献来对IV药物类别进行特征分析，以确定液体管理的目标。这项多中心回顾性巢式队列研究纳入了2017年1月至2018年12月期间入住内科或外科ICU的患者。主要结局是确定在ICU的前3天内给予的特定IV药物类别的液体量贡献。次要结局是这些药物的给药频率及其在前3个ICU日的每日总液体摄入量中的比例。该研究包括210名患者。在ICU的前3天中，平均给药量最大的是抗菌药物（968±846 mL）、维生素/矿物质/电解质（416±935 mL）、止痛/镇静/抗谵妄药物（310±512 mL）和血管活性药物（282±744 mL）。在ICU的前3天中，给药频率最高的是抗菌药物（n = 180；86%）、止痛/镇静/抗谵妄药物（n = 143；68%）、维生素/矿物质/电解质（n = 123；59%）和血管活性药物（n = 96；46%）。在ICU的前3天中，IV药物每位患者的液体量贡献为2601±2573 mL，占总体积的42%±29%。在ICU入院的前3天内，IV药物占总液体摄入量的40%以上，抗菌药物是给药量和给药频率的主要贡献者。未来应开展研究，对ICU的液体来源实施液体管理，如浓缩IV药物、将IV药物转换为口服制剂、抗菌药物降阶梯治疗以及减少维持液量，以尽量减少IV药物带来的隐性液体。
