Korean J Crit Care Med.  2016 Nov;31(4):276-299. 10.4266/kjccm.2016.00934.

The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation

• Glassford
• Bellomo R

• KMID: 2371184
• DOI: http://doi.org/10.4266/kjccm.2016.00934

Abstract

Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.

Keyword

fluid bolus therapy; fluid overload; intravenous fluid therapy; mortality; patient-centred outcome; resuscitation

MeSH Terms

Delivery of Health Care
Epidemiology
Humans
Mortality
Resuscitation
Risk Factors

Figure

• 

  Fig. 1. Mechanisms of fluid accumulation and loss. CPB: cardiopulmonary bypass; FBT: fluid bolus therapy ECMO: extracorporeal membrane oxygenation; CRRT: continuous renal replacement therapy; SIADH: syndrome of inappropriate anti-diuretic hormone secretion; ADH: anti-diuretic hormone; DI: diabetes insipidus; CSW: cerebral salt wasting; CCF: congestive cardiac failure; Portal HT: portal hypertension; CLD: chronic liver disease; AKI: acute kidney injury; CKD: chronic kidney disease; HRS: hepato-renal syndrome; PLE: protein-losing enteropathy; DM: diabetes mellitus.

• 

  Fig. 2. Consequences of fluid accumulation and oedema at an organ level. LFTs: liver function tests; TPN: total parenteral nutrition.

Reference

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