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



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


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.


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).


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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  1. Finfer S, Liu B, Taylor C, Bellomo R, Billot L, Cook D et al (2010) Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care 14:R185

    PubMed Central  Article  PubMed  Google Scholar 

  2. SAFE Study Investigators (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256

    Article  Google Scholar 

  3. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139

    CAS  Article  PubMed  Google Scholar 

  4. Myburgh J, Finfer S, Bellomo R, Billot L, Cass A, Gattas D et al (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 367:1901–1911

    CAS  Article  PubMed  Google Scholar 

  5. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A et al (2012) Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med 367:124–134

    CAS  Article  PubMed  Google Scholar 

  6. SAFE Study Investigators (2007) Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med 357:874–884

    Article  Google Scholar 

  7. The SAFE Study Investigators (2011) Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med 37:86–96

    Article  Google Scholar 

  8. Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M et al (2014) Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 10:1412–1421

    Article  Google Scholar 

  9. Guidet B, Martinet O, Boulain T, Philippart F, Poussel JF, Maizel J et al (2012) Assessment of hemodynamic efficacy and safety of 6 % hydroxyethyl starch 130/0.4 vs. 0.9 % NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Crit Care 16:R94

    PubMed Central  Article  PubMed  Google Scholar 

  10. Perel P, Roberts I, Ker K (2013) Colloids versus crystalloids for fluid resuscitation in critically ill patients (review). Cochrane Database System Rev 2:CD000567

    Google Scholar 

  11. Mutter TC, Ruth CA, Dart AB (2013) Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev 7:CD007594

    PubMed  Google Scholar 

  12. Haase N, Perner A, Inkeri Hennings L, Siegemund M, Lauridsen B, Wetterslev M et al (2013) Hydroxyethyl starch 130/0.38–0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis. BMJ 346:f839

    PubMed Central  Article  PubMed  Google Scholar 

  13. Zarychanski R, Abou-Setta A, Turgeon A, Houston B, McIntyre L, Marshall J et al (2013) Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA 309:678–688

    CAS  Article  PubMed  Google Scholar 

  14. Gattas D, Dan A, Myburgh J, Billot L, Lo S, Finfer S et al (2013) Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4) and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacment therapy. Intensive Care Med 39:558–568

    CAS  Article  PubMed  Google Scholar 

  15. Powell-Tuck J, Gosling P, Lobo D, Allison S, Carlson G, Gore M et al (2011) British Consensus Guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP). Accessed 22 May 2015

  16. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228

    CAS  Article  PubMed  Google Scholar 

  17. FDA (2005) Safety of albumin administration in critically ill patients. Accessed 22 May 2015

  18. EMA (2013) PRAC recommends suspending marketing authorisations for infusion solutions containing hydroxyethyl-starch. Accessed 22 May 2015

  19. FDA (2013) Hydroxyethyl starch solutions: FDA safety communication—boxed warning on increased mortality and severe renal injury and risk of bleeding. Accessed 22 May 2015

  20. MHRA (2013) Hydroxyethyl starch (HES) products—increased risk of renal dysfunction and mortality. Accessed 22 May 2015

  21. TGA (2013) Hydroxyethyl starch (Voluven and Volulyte) and increased risk of mortality. Accessed 22 May 2015

  22. FDA (2013) FDA Safety Communication: Boxed Warning on increased mortality and severe renal injury, and additional warning on risk of bleeding, for use of hydroxyethyl starch solutions in some settings. Accessed 22 May 2015

  23. Yunos NM, Bellomo R, Glassford N, Sutcliffe H, Lam Q, Bailey M (2014) Chloride-liberal vs. chloride-restrictive intravenous fluid administration and acute kidney injury: an extended analysis. Intensive Care Med 41:257–264

    Article  PubMed  Google Scholar 

  24. Yunos N, Bellomo R, Hegarty C, Story D, Ho L, Bailey M (2012) Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 308:1566–1572

    CAS  Article  PubMed  Google Scholar 

  25. Shaw A, Bagshaw S, Goldstein S et al (2012) Major complications, mortality, and resource utilization after open abdominal surgery: 0.9 % saline compared to plasma-lyte. Ann Surg 255:821–829

    Article  PubMed  Google Scholar 

  26. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    PubMed Central  Article  PubMed  Google Scholar 

  27. Knaus W, Draper E, Wagner D, Zimmerman J (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    CAS  Article  PubMed  Google Scholar 

  28. Miletin M, Stewart T, Norton P (2002) Influences on physicians’ choices of intravenous colloids. Intensive Care Med 28:917–924

    Article  PubMed  Google Scholar 

  29. Schortgen F, Deye N, Brochard L, CRYCO Study Group (2004) Preferred plasma volume expanders for critically ill patients: results of an international survey. Intensive Care Med 30:2222–2229

    Article  PubMed  Google Scholar 

  30. The FLUID study Investigators (2008) Preference for colloid use in Scandinavian intensive care units. Acta Anaesthesiol Scand 52:750–758

    Article  Google Scholar 

  31. Zhou F, Peng Z, Bishop J, Cove M, Singbartl K, Kellum J (2014) Effects of fluid resuscitation with 0.9 % saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis. Crit Care Med 42:e270–e278

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  32. Yunos NM, Kim IB, Bellomo R, Bailey M, Ho L, Story D et al (2011) The biochemical effects of restricting chloride-rich fluids in intensive care. Crit Care Med 39:2419–2424

    CAS  Article  PubMed  Google Scholar 

  33. Raghunathan K, Shaw A, Nathanson B, Stürmer T, Brookhart A, Stefan M et al (2014) Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med 42:1585–1591

    CAS  Article  PubMed  Google Scholar 

  34. The National Heart L, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trial Network (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575

    Article  Google Scholar 

  35. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA (2011) Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 39:259–265

    Article  PubMed  Google Scholar 

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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.

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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).

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