Distribution of crystalloid fluid changes with the rate of infusion: a population‐based study

Hahn, Robert G.; Drobin, Dan; Zdolsek, Joachim

doi:10.1111/aas.12686

Cited by 42 publications

(50 citation statements)

References 28 publications

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“…Infusion of small volumes in conscious humans, such as 2‐5 mL/kg over 15‐30 minutes, are rapidly excreted and only a limited fraction of the fluid undergoes distribution . Hence, they are effective plasma volume expanders (Figure ).…”

Section: Crystalloid Fluidmentioning

confidence: 99%

“…Peripheral accumulation is more profound with the high‐rate infusion. Simulation based on data from conscious volunteers …”

Section: Crystalloid Fluidmentioning

confidence: 99%

“…The greater stability of the population kinetic approach has made possible the routine estimation of k b , which describes a first‐order rather than a zero‐order process . The value of k b appears to be 1/5 to 1/3 of the k 10 in volunteers, while k b attains a value similar to, or even higher than, k 10 during general anesthesia (Table ). This flow is believed to be filtered fluid that is not in balance with the circulating plasma.…”

Section: Miscellaneousmentioning

confidence: 99%

“…Infusion of small volumes in conscious humans, such as 2-5 mL/kg over 15-30 minutes, are rapidly excreted and only a limited fraction of the fluid undergoes distribution. 15 Hence, they are effective plasma volume expanders ( Figure 6). The reason is probably that the increased filtration pressure is not sufficient to expand the gel-like interstitial matrix.…”

Section: Small Volumesmentioning

confidence: 99%

“…Simulation based on data from conscious volunteers. 15 surgery. 31 Although a colloid stimulates diuresis during surgery and shortly thereafter, the urinary excretion might be lowered on the first post-operative day once the colloid has been excreted/ metabolized.…”

Section: F I G U R Ementioning

confidence: 99%

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Understanding volume kinetics

Hahn

2020

Acta Anaesthesiol Scand

106

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The distribution and elimination kinetics of the water volume in infusion fluids can be studied by volume kinetics. The approach is a modification of drug pharmacokinetics and uses repeated measurements of blood hemoglobin and urinary excretion as input variables in (usually) a two‐compartment model with expandable walls. Study results show that crystalloid fluid has a distribution phase that gives these fluids a plasma volume expansion amounting to 50%‐60% of the infused volume as long as the infusion lasts, while the fraction is reduced to 15%‐20% within 30 minutes after the infusion ends. Small volumes of crystalloid barely distribute to the interstitium, whereas rapid infusions tend to cause edema. Fluid elimination is very slow during general anesthesia due to the vasodilatation‐induced reduction of the arterial pressure, whereas elimination is less affected by hemorrhage. The half‐life is twice as long for saline than for Ringer solutions. Elimination is slower in conscious males than conscious females, and high red blood cell and thrombocyte counts retard both distribution and re‐distribution. Children have faster turnover than adults. Plasma volume expansions are similar for glucose solutions and Ringer's, but the expansion duration is shorter for glucose. Concentrated urine before and during infusion slows down the elimination of crystalloid fluid. Colloid fluids have no distribution phase, an intravascular persistence half‐life of 2‐3 hours, and—at least for hydroxyethyl starch—the ability to reduce the effect of subsequently infused crystalloids. Accelerated distribution due to degradation of the endothelial glycocalyx layer has not yet been demonstrated.

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Section: Crystalloid Fluidmentioning

confidence: 99%

“…Peripheral accumulation is more profound with the high‐rate infusion. Simulation based on data from conscious volunteers …”

Section: Crystalloid Fluidmentioning

confidence: 99%

Section: Miscellaneousmentioning

confidence: 99%

Section: Small Volumesmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

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Understanding volume kinetics

Hahn

2020

Acta Anaesthesiol Scand

106

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Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients

Zampieri

Machado

Biondi

et al. 2021

JAMA

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for the BaSICS investigators and the BRICNet members IMPORTANCE Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.OBJECTIVE To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).INTERVENTIONS Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design. MAIN OUTCOMES AND MEASURESThe primary end point was 90-day survival.RESULTS Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).CONCLUSIONS AND RELEVANCE Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

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Restricted or Liberal Fluid Therapy

Woodcock

2020

Perioperative Fluid Management

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Distribution of crystalloid fluid changes with the rate of infusion: a population‐based study

Cited by 42 publications

References 28 publications

Understanding volume kinetics

Understanding volume kinetics

Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients

Restricted or Liberal Fluid Therapy

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