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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2018

Open Access 01-04-2018 | Original

Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population

Authors: Niels Van Regenmortel, Walter Verbrugghe, Ella Roelant, Tim Van den Wyngaert, Philippe G. Jorens

Published in: Intensive Care Medicine | Issue 4/2018

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Abstract

Purpose

Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes.

Methods

We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients’ chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity.

Results

Maintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308–1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5–31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9–3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids.

Conclusions

Inadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.
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Metadata
Title
Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population
Authors
Niels Van Regenmortel
Walter Verbrugghe
Ella Roelant
Tim Van den Wyngaert
Philippe G. Jorens
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 4/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5147-3

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