Abstract
BackgroundFluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Therefore, our goal was to investigate the practice patterns of fluid utilization for resuscitation of adult patients in intensive care units (ICUs) within the USA.MethodsWe conducted a cross-sectional online survey of 502 physicians practicing in medical and surgical ICUs. Survey questions were designed to assess clinical decision-making processes for 3 types of patients who need volume expansion: (1) not bleeding and not septic, (2) bleeding but not septic, (3) requiring resuscitation for sepsis. First-choice fluid used in fluid boluses for these 3 patient types was requested from the respondents. Descriptive statistics were performed using a Kruskal-Wallis test to evaluate differences among the physician groups. Follow-up tests, including t tests, were conducted to evaluate differences between ICU types, hospital settings, and bolus volume.ResultsFluid resuscitation varied with respect to preferences for the factors to determine volume status and preferences for fluid types. The 3 most frequently preferred volume indicators were blood pressure, urine output, and central venous pressure. Regardless of the patient type, the most preferred fluid type was crystalloid, followed by 5 % albumin and then 6 % hydroxyethyl starches (HES) 450/0.70 and 6 % HES 600/0.75. Surprisingly, up to 10 % of physicians still chose HES as the first choice of fluid for resuscitation in sepsis. The clinical specialty and the practice setting of the treating physicians also influenced fluid choices.ConclusionsPractice patterns of fluid resuscitation varied in the USA, depending on patient characteristics, clinical specialties, and practice settings of the treating physicians.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-016-0035-2) contains supplementary material, which is available to authorized users.
Highlights
Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states
The objectives of this study were the following: (A) to examine the use of different types of fluids for resuscitation in critically ill patients in adult intensive care units within the USA; (B) to determine whether certain patient characteristics and/or practice settings have an influence on the type of fluid utilized for resuscitation; and (C) to determine whether the fluid selected for resuscitation varies by clinical specialties of the treating physicians
The majority of anesthesiologists and surgeons practiced in surgical intensive care unit (ICU), while the majority of critical care medicine specialists and pulmonologists were from medical ICUs
Summary
Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. If a patient has an intact EGL and an intravascular volume deficit, volume therapy with a colloid fluid restores the intravascular volume as predicted by Starling, and far higher volumes of crystalloids are required to achieve the same result (Rehm et al 2000). In this context, at least theoretically, colloids may have advantages over crystalloids (Roger et al 2014)
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