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Resuscitation fluid use in Australian and New Zealand Intensive Care Units between 2007 and 2013

Abstract

Introduction

Recent evidence indicates that the choice of intravenous fluids may affect outcomes in critically ill patients.

Methods

We recorded the administration of resuscitation fluids in patients admitted to Australian and New Zealand adult intensive care units (ICUs) for a 24-h period at 6 time points between 2007 and 2013. Changes in patterns of fluid use over this period were determined using regression analyses.

Results

Of the 2825 patients admitted to the 61 ICUs on the 6 study days, 754 (26.7 %) patients received fluid resuscitation. Of those receiving fluid resuscitation, the proportion of patients receiving crystalloid significantly increased from 28.9 % (41/142) in 2007 to 50.5 % (48/95) in 2013 (adjusted odds ratio (OR) 2.93; 95 % confidence intervals (CI) 1.35–6.33; p = 0.006); of these, the proportion of patients receiving buffered salt solutions significantly increased from 4.9 % (7/142) in 2007 to 31.6 % (30/95) in 2013 (OR 7.00; 95 % CI 2.14–22.92; p = 0.001). The use of colloids significantly decreased from 59.9 % (85/142) in 2007 to 42.1 % (40/95) in 2013 (adjusted OR 0.34; 95 % CI 0.16–0.74; p = 0.007) due to a significant decrease in the proportion of patients receiving gelatin; 28.9 % (41/142) to 2.1 % (2/95) (OR 0.10; 95 % CI 0.03–0.29; p ≤ 0.001).

Conclusion

Fluid resuscitation practice in Australia and New Zealand adult ICUs has changed over the 6-year study period. Crystalloid use increased primarily due to an increase in the use of buffered salt solutions while overall the use of colloid has decreased.

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Conflicts of interest

The George Institute for Global Health, the institution of NH, CT, MS, SF, PG, LW, and JM, has received unrestricted grants (administered through the University of Sydney) and travel expenses (SF, JM) in relation to the design and conduct of the Crystalloid versus Hydroxyethyl Starch Trial from Fresenius Kabi, and an unrestricted grant (SF) and advisory board fees and travel expenses (JM) from Baxter HealthCare in relation to fluid resuscitation research (2014). NH received a National Health and Medical Research Council of Australia post-graduate scholarship (2012–2014) that has supported part of this work. CT undertakes consulting work for pharmaceutical companies. CT has not personally undertaken work for CSL, Fresenius Kabi or Baxter. BL owns shares in BioCSL. IS has no conflicts of interest. JM is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia.

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Correspondence to N. E. Hammond.

Additional information

For the George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group.

Take-home message: Fluid resuscitation in Australian and New Zealand ICUs changed over a 6-year period with an increased use of crystalloids, primarily due to increased use of buffered salt solutions. Albumin is the most commonly used colloid solution, although the overall use of colloids has decreased, associated with a decrease in the use of gelatin solutions and negligible use of HES.

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Hammond, N.E., Taylor, C., Saxena, M. et al. Resuscitation fluid use in Australian and New Zealand Intensive Care Units between 2007 and 2013. Intensive Care Med 41, 1611–1619 (2015). https://doi.org/10.1007/s00134-015-3878-y

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  • DOI: https://doi.org/10.1007/s00134-015-3878-y

Keywords

  • Intensive care
  • Fluid resuscitation
  • Colloid
  • Crystalloid
  • Point prevalence
  • Time trend