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Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units
INTRODUCTION: Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. METHODS: We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episo...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219291/ https://www.ncbi.nlm.nih.gov/pubmed/20950434 http://dx.doi.org/10.1186/cc9293 |
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author | Finfer, Simon Liu, Bette Taylor, Colman Bellomo, Rinaldo Billot, Laurent Cook, Deborah Du, Bin McArthur, Colin Myburgh, John |
author_facet | Finfer, Simon Liu, Bette Taylor, Colman Bellomo, Rinaldo Billot, Laurent Cook, Deborah Du, Bin McArthur, Colin Myburgh, John |
author_sort | Finfer, Simon |
collection | PubMed |
description | INTRODUCTION: Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. METHODS: We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). RESULTS: During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). CONCLUSIONS: Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were. |
format | Online Article Text |
id | pubmed-3219291 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-32192912011-11-18 Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units Finfer, Simon Liu, Bette Taylor, Colman Bellomo, Rinaldo Billot, Laurent Cook, Deborah Du, Bin McArthur, Colin Myburgh, John Crit Care Research INTRODUCTION: Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. METHODS: We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). RESULTS: During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). CONCLUSIONS: Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were. BioMed Central 2010 2010-10-15 /pmc/articles/PMC3219291/ /pubmed/20950434 http://dx.doi.org/10.1186/cc9293 Text en Copyright ©2010 Finfer et al.; licensee BioMed Central Ltd http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited |
spellingShingle | Research Finfer, Simon Liu, Bette Taylor, Colman Bellomo, Rinaldo Billot, Laurent Cook, Deborah Du, Bin McArthur, Colin Myburgh, John Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
title | Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
title_full | Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
title_fullStr | Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
title_full_unstemmed | Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
title_short | Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
title_sort | resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219291/ https://www.ncbi.nlm.nih.gov/pubmed/20950434 http://dx.doi.org/10.1186/cc9293 |
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