Porth J, Ajouri J, Kleinlein M, Höckel M, Elke G, Meybohm P, Culmsee C, Muellenbach R M
Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland.
Institut für Pharmakologie und Klinische Pharmazie, Phillips Universität Marburg, Marburg, Deutschland.
Anaesthesiologie. 2024 Feb;73(2):85-92. doi: 10.1007/s00101-024-01379-4. Epub 2024 Jan 30.
The administration of intravenous fluids includes various indications, e.g., fluid replacement, nutritional therapy or as a solvent for drugs and is a common routine in the intensive care unit (ICU); however, overuse of intravenous fluids can lead to fluid overload, which can be associated with a poorer outcome in critically ill patients.
The aim of this survey was to find out the current status of the use and management of intravenous fluids as well as the interprofessional cooperation involving clinical pharmacists on German ICUs.
An online survey with 33 questions was developed. The answers of 62 participants from the Scientific Working Group on Intensive Care Medicine of the German Society for Anesthesiology and Intensive Care Medicine were evaluated.
Fluid overload occurs "frequently" in 62.9% (39/62) and "very frequently" in 9.7% (6/62) of the ICUs of respondents. An established standard for an infusion management system is unknown to 71.0% (44/62) of participants and 45.2% of the respondents stated that they did not have a patient data management system. In addition, the participants indicated how they define fluid overload. This was defined by the presence of edema by 50.9% (28/55) and by positive fluid balance by 30.9% (17/55). According to the participants septic patients (38/60; 63.3%) and cardiological/cardiac surgical patients (26/60; 43.3%) are most susceptible to the occurrence of fluid overload. Interprofessional collaboration among intensive care physicians, critical care nurses, and clinical pharmacists to optimize fluid therapy was described as "relevant" by 38.7% (24/62) and "very relevant" by 45.2% (28/62). Participants with clinical pharmacists on the wards (24/62; 38.7%) answered this question more often as "very relevant" with 62.5% (15/24).
Fluid overload is a frequent and relevant problem in German intensive care units. Yet there are few established standards in this area. There is also a lack of validated diagnostic parameters and a clear definition of fluid overload. These are required to ensure appropriate and effective treatment that is tailored to the patient and adapted to the respective situation. Intravenous fluids should be considered as drugs that may exert side effects or can be overdosed with severe adverse consequences for the patients. One approach to optimize fluid therapy could be achieved by a fluid stewardship corresponding to comparable established procedures of the antibiotic stewardship. In particular, fluid stewardship will contribute to drug safety of intravenous fluids profiting from joined expertise in a setting of interprofessional collaboration. An important principle of fluid stewardship is to consider intravenous fluids in the same way as medication in terms of their importance. Furthermore, more in-depth studies are needed to investigate the effects of interprofessional fluid stewardship in a prospective and controlled manner.
静脉输液的应用包括多种适应证，如补液、营养治疗或作为药物的溶剂，这在重症监护病房（ICU）是常见的常规操作；然而，静脉输液的过度使用会导致液体超负荷，这可能与危重症患者较差的预后相关。
本次调查的目的是了解德国ICU中静脉输液的使用和管理现状以及涉及临床药师的跨专业合作情况。
设计了一项包含33个问题的在线调查。对来自德国麻醉和重症医学学会重症医学科学工作组的62名参与者的回答进行了评估。
在受访者的ICU中，62.9%（39/62）的科室液体超负荷“频繁”发生，9.7%（6/62）的科室“非常频繁”发生。71.0%（44/62）的参与者不知道输液管理系统的既定标准，45.2%的受访者表示他们没有患者数据管理系统。此外，参与者指出了他们如何定义液体超负荷。50.9%（28/55）的人通过水肿的存在来定义，30.9%（17/55）的人通过正液体平衡来定义。据参与者称，脓毒症患者（38/60；63.3%）和心脏病学/心脏外科患者（26/60；43.3%）最易发生液体超负荷。38.7%（24/62）的人将重症监护医生、重症护理护士和临床药师之间为优化液体治疗而进行的跨专业协作描述为“相关”，45.2%（28/62）的人描述为“非常相关”。病房中有临床药师的参与者（24/62；38.7%）中，62.5%（15/24）的人更常将这个问题回答为“非常相关”。
液体超负荷在德国重症监护病房是一个常见且相关的问题。然而，该领域既定标准较少。也缺乏经过验证的诊断参数和对液体超负荷的明确定义。这些对于确保针对患者并适应具体情况的适当且有效的治疗是必需的。静脉输液应被视为可能产生副作用或可能过量使用并给患者带来严重不良后果的药物。一种优化液体治疗的方法可以通过与抗生素管理类似的既定程序相对应的液体管理来实现。特别是，液体管理将有助于静脉输液的药物安全，受益于跨专业协作环境中的联合专业知识。液体管理的一个重要原则是以与药物相同的方式重视静脉输液。此外，需要进行更深入的研究，以前瞻性和对照的方式调查跨专业液体管理的效果。
