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Resuscitation fluid use in critically ill adults: an international cross sectional study in 391 intensive care units
- Source :
- Critical Care
- Publication Year :
- 2010
- Publisher :
- Springer Science and Business Media LLC, 2010.
-
Abstract
- Introduction Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. Methods We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). Results During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). Conclusions Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.
- Subjects :
- Adult
Male
endocrine system
medicine.medical_specialty
Resuscitation
Internationality
Cross-sectional study
Critical Illness
Critical Care and Intensive Care Medicine
complex mixtures
Resuscitation fluid
Intensive care
medicine
Humans
Colloids
Medical prescription
Intensive care medicine
Generalized estimating equation
Aged
critically ill adults
business.industry
Research
digestive, oral, and skin physiology
Odds ratio
Middle Aged
Confidence interval
body regions
Intensive Care Units
Cross-Sectional Studies
intensive care units
Emergency medicine
Commentary
Fluid Therapy
Female
business
Perfusion
Subjects
Details
- ISSN :
- 13648535
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Critical Care
- Accession number :
- edsair.doi.dedup.....52bc8c65f225f455ecfa352653262d4e