Hidden Obligatory Fluid Intake in Critical Care Patients

Bashir, Muhammad Umair; Tawil, Anan; Mani, Vishnu R.; Farooq, Umer; DeVita, Michael A.

doi:10.1177/0885066615625181

Cited by 17 publications

(17 citation statements)

References 9 publications

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“…renal, gastrointestinal, insensible) and replacement fluids if the patient is experiencing ongoing losses because of unresolved pathologic conditions [ 1 , 76 ]. Since persistence of a positive daily fluid balance over time is strongly associated with a higher mortality rate in septic patients [ 11 , 77 ], clinicians should also be aware of the hidden obligatory fluid intake, as it may contribute more than a litre daily [ 78 ].…”

Section: The Four Phases Of Fluid Therapymentioning

confidence: 99%

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Malbrain

Regenmortel

Saugel

et al. 2018

Ann. Intensive Care

418

306

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In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the “four D’s” of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are “When to start intravenous fluids?”, “When to stop intravenous fluids?”, “When to start de-resuscitation or active fluid removal?” and finally “When to stop de-resuscitation?” In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.

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Section: The Four Phases Of Fluid Therapymentioning

confidence: 99%

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Malbrain

Regenmortel

Saugel

et al. 2018

Ann. Intensive Care

418

306

View full text Add to dashboard Cite

show abstract

“…An observational study characterized the contribution of “obligatory” fluids (necessary diluents for delivery of drugs) and “discretionary” fluids (mIVF, resuscitation boluses, and nutrition) and observed that patients received a median obligatory fluid volume of 645 mL (IQR: 495-1000 mL) with an additional discretionary fluid volume of 2592 mL (IQR: 2000-3030 mL) during a random 24-hour period of ICU admission. 31 Careful attention to the contribution of hidden fluids to daily input has the potential to reduce FO.…”

Section: Fluid Overload Necessitates Stewardshipmentioning

confidence: 99%

Fluid Stewardship During Critical Illness: A Call to Action

Hawkins

Smith

Newsome

et al. 2019

Journal of Pharmacy Practice

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Intravenous fluids (IVFs) are the most common drugs administered in the intensive care unit. Despite the ubiquitous use, IVFs are not benign and carry significant risks associated with under- or overadministration. Hypovolemia is associated with decreased organ perfusion, ischemia, and multi-organ failure. Hypervolemia and volume overload are associated with organ dysfunction, delayed liberation from mechanical ventilation, and increased mortality. Despite appropriate provision of IVF, adverse drug effects such as electrolyte abnormalities and acid–base disturbances may occur. The management of volume status in critically ill patients is both dynamic and tenuous, a process that requires frequent monitoring and high clinical acumen. Because patient-specific considerations for fluid therapy evolve across the continuum of critical illness, a standard approach to the assessment of fluid needs and prescription of IVF therapy is necessary. We propose the principle of “fluid stewardship,” guided by 4 rights of medication safety: right patient, right drug, right route, and right dose. The successful implementation of fluid stewardship will aid pharmacists in making decisions regarding IVF therapy to optimize hemodynamic management and improve patient outcomes. Additionally, we highlight several areas of focus for future research, guided by the 4 rights construct of fluid stewardship.

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“… 1 , 5 – 8 Fluids administered for this purpose are “discretionary fluids” and contribute positively to the patient’s net fluid balance. 25 …”

Section: Rationalementioning

confidence: 99%

“…1,[5][6][7][8] Fluids administered for this purpose are "discretionary fluids" and contribute positively to the patient's net fluid balance. 25 Accumulating evidence suggests that a positive fluid balance after the initial resuscitation phase worsens outcomes in critically ill patients. [26][27][28] This creates a clinical dilemma regarding how best to therapeutically approach volume status in hypernatremic resuscitated patients.…”

mentioning

confidence: 99%

Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review

2018

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Background:Healthcare-acquired hypernatremia (serum sodium >145 mEq/dL) is common among critically ill and other hospitalized patients and is usually treated with hypotonic fluid and/or diuretics to correct a “free water deficit.” However, many hypernatremic patients are eu- or hypervolemic, and an evolving body of literature emphasizes the importance of rapidly returning critically ill patients to a neutral fluid balance after resuscitation.Objective:We searched for any randomized- or observational-controlled studies evaluating the impact of active interventions intended to correct hypernatremia to eunatremia on any outcome in volume-resuscitated patients with shock and/or sepsis.Data sources:We performed a systematic literature search with studies identified by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, Index-Catalogue of the Library of the Surgeon General’s Office, DARE (Database of Reviews of Effects), and CINAHL and scanning reference lists of relevant articles with abstracts published in English.Data synthesis:We found no randomized- or observational-controlled trials measuring the impact of active correction of hypernatremia on any outcome in resuscitated patients.Conclusion:Recommendations for active correction of hypernatremia in resuscitated patients with sepsis or shock are unsupported by clinical research acceptable by modern evidence standards.

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Hidden Obligatory Fluid Intake in Critical Care Patients

Abstract: Hidden obligatory fluids constitute a major source of the fluid intake among patients in a critical care unit. Up to 1.5 L should be taken into account during daily decision making to effectively regulate their volumes.

Cited by 17 publications

References 9 publications

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

Fluid Stewardship During Critical Illness: A Call to Action

Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review

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