Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

Abstract

Intravenous fluid administration should be considered as any other pharmacological prescription. There are three main indications: resuscitation, replacement, and maintenance. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. As for antibiotics, intravenous fluid administration should follow the four Ds: drug, dosing, duration, de-escalation. Among crystalloids, balanced solutions limit acid-base alterations and chloride load and should be preferred, as this likely prevents renal dysfunction. Among colloids, albumin, the only available natural colloid, may have beneficial effects. The last decade has seen growing interest in the potential harms related to fluid overloading. In the perioperative setting, appropriate fluid management that maintains adequate organ perfusion while limiting fluid administration should represent the standard of care. Protocols including a restrictive continuous fluid administration alongside bolus administration to achieve hemodynamic targets have been proposed. A similar approach should be considered also for critically ill patients, in whom increased endothelial permeability makes this strategy more relevant. Active de-escalation protocols may be necessary in a later phase. The R.O.S.E. conceptual model (Resuscitation, Optimization, Stabilization, Evacuation) summarizes accurately a dynamic approach to fluid therapy, maximizing benefits and minimizing harms. Even in specific categories of critically ill patients, i.e., with trauma or burns, fluid therapy should be carefully applied, considering the importance of their specific aims; maintaining peripheral oxygen delivery, while avoiding the consequences of fluid overload.

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    Silva JM, de Oliveira AM, Nogueira FA, Vianna PM, Pereira Filho MC, Dias LF, et al. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013;17(6):R288.

    Not in our library10.1186/cc13151

96. 96.

    Marik PE, Linde-Zwirble WT, Bittner EA, Sahatjian J, Hansell D. Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med. 2017;43(5):625-632.

    Not in our library10.1007/s00134-016-4675-y

97. 97.

    Cordemans C, De Laet I, Van Regenmortel N, Schoonheydt K, Dits H, Martin G, et al. Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure: a pilot study looking at the effects of PAL-treatment. Ann Intensive Care. 2012;2(Suppl 1):S15.

    Not in our library10.1186/2110-5820-2-s1-s15

98. 98.
    Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance · 2012

    No notice
99. 99.

    Dabrowski W, Kotlinska-Hasiec E, Schneditz D, Zaluska W, Rzecki Z, De Keulenaer B, et al. Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure. Clin Nephrol. 2014;82(1):41-50.

    Not in our library10.5414/cn108015

100. 100.

     Mikkelsen ME, Christie JD, Lanken PN, Biester RC, Thompson BT, Bellamy SL, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012;185(12):1307-1315.

     Not in our library10.1164/rccm.201111-2025oc

101. 101.

     Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, et al. Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth. 2014;113(5):740-747.

     Not in our library10.1093/bja/aeu300

102. 102.

     Silversides JA, Perner A, Malbrain M. Liberal versus restrictive fluid therapy in critically ill patients. Intensive Care Med. 2019;45(10):1440-1442.

     Not in our library10.1007/s00134-019-05713-y

103. 103.

     Cecconi M, Hofer C, Teboul JL, Pettila V, Wilkman E, Molnar Z, et al. Fluid challenges in intensive care: the FENICE study: a global inception cohort study. Intensive Care Med. 2015;41(9):1529-1537.

     Not in our library10.1007/s00134-015-3850-x

104. 104.

     Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med. 2006;34(5):1333-1337.

     Not in our library10.1097/01.ccm.0000214677.76535.a5

105. 105.

     Vincent JL. Let’s give some fluid and see what happens” versus the “mini-fluid challenge. Anesthesiology. 2011;115(3):455-456.

     Not in our library10.1097/aln.0b013e318229a521

106. 106.

     Bennett VA, Vidouris A, Cecconi M. Effects of fluids on the macro- and microcirculations. Crit Care. 2018;22(1):74.

     Not in our library10.1186/s13054-018-1993-1

107. 107.

     Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901-1911.

     Not in our library10.1056/nejmoa1209759

108. 108.

     Uz Z, Ince C, Guerci P, Ince Y, Araujo RP, Ergin B, et al. Recruitment of sublingual microcirculation using handheld incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase-a pilot study in post ICU cardiac surgery patients. Perioperat Med. 2018;7:18.

     Not in our library10.1186/s13741-018-0091-x

109. 109.

     Paxian M, Bauer I, Rensing H, Jaeschke H, Mautes AE, Kolb SA, et al. Recovery of hepatocellular ATP and “pericentral apoptosis” after hemorrhage and resuscitation. FASEB J. 2003;17(9):993-1002.

     Not in our library10.1096/fj.02-0624com

110. 110.

     Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008;64(5):1211-1217.

     Not in our library10.1097/ta.0b013e318169cd3c

111. 111.
     Early and individualized goal-directed therapy for trauma-induced coagulopathy · 2012

     No notice
112. 112.

     Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32.

     Not in our library10.1016/s0140-6736(10)60835-5

113. 113.

     Valle EJ, Allen CJ, Van Haren RM, Jouria JM, Li H, Livingstone AS, et al. Do all trauma patients benefit from tranexamic acid? J Trauma Acute Care Surg. 2014;76(6):1373-1378.

     Not in our library10.1097/ta.0000000000000242

114. 114.

     Peeters Y, Vandervelden S, Wise R, Malbrain ML. An overview on fluid resuscitation and resuscitation endpoints in burns: past, present and future. Part 1—historical background, resuscitation fluid and adjunctive treatment. Anaesthesiol Intensive Ther. 2015;47(Spec No):s6-s14.

     Not in our library10.5603/ait.a2015.0063

115. 115.

     Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci. 1968;150(3):874-894.

     Not in our library10.1111/j.1749-6632.1968.tb14738.x

116. 116.

     Cartotto R, Zhou A. Fluid creep: the pendulum hasn’t swung back yet! J Burn Care Res. 2010;31(4):551-558.

     Not in our library10.1097/bcr.0b013e3181e4d732

117. 117.

     Strang SG, Van Lieshout EM, Breederveld RS, Van Waes OJ. A systematic review on intra-abdominal pressure in severely burned patients. Burns. 2014;40(1):9-16.

     Not in our library10.1016/j.burns.2013.07.001

118. 118.

     Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190-1206.

     Not in our library10.1007/s00134-013-2906-z

119. 119.

     Pruitt BA. Protection from excessive resuscitation: “pushing the pendulum back”. J Trauma. 2000;49(3):567-568.

     Not in our library10.1097/00005373-200009000-00030

120. 120.

     Sullivan SR, Ahmadi AJ, Singh CN, Sires BS, Engrav LH, Gibran NS, et al. Elevated orbital pressure: another untoward effect of massive resuscitation after burn injury. J Trauma. 2006;60(1):72-76.

     Not in our library10.1097/01.ta.0000197657.25382.b2

121. 121.

     Gille J, Klezcewski B, Malcharek M, Raff T, Mogk M, Sablotzki A, et al. Safety of resuscitation with Ringer’s acetate solution in severe burn (VolTRAB)—an observational trial. Burns. 2014;40(5):871-880.

     Not in our library10.1016/j.burns.2013.11.021

122. 122.

     Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974;1(4):693-703.

     Not in our library

123. 123.
     Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study · 2012

     No notice
124. 124.

     Cochran A, Morris SE, Edelman LS, Saffle JR. Burn patient characteristics and outcomes following resuscitation with albumin. Burns. 2007;33(1):25-30.

     Not in our library10.1016/j.burns.2006.10.005

125. 125.

     Lawrence A, Faraklas I, Watkins H, Allen A, Cochran A, Morris S, et al. Colloid administration normalizes resuscitation ratio and ameliorates “fluid creep”. J Burn Care Res. 2010;31(1):40-47.

     Not in our library10.1097/bcr.0b013e3181cb8c72

126. 126.

     Malbrain ML, Rice T, Mythen M, Wuyts S. It is time for improved fluid stewardship. ICU Manag Pract. 2018;18(3):158-162.

     Not in our library

Cited by papers we hold 3

• Prediction of fluid responsiveness. What’s new? · 2022
  No notice
• Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review · 2020
  Not checked
• COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup · 2020
  Corrected

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.