15 - Fluid therapy

Summary

Despite hundreds of laboratory and clinical studies, the choice of intravenous (IV) fluid, the volume of fluid to be administered, and the timing of fluid administration remain controversial. Based on the evidence from clinical trials and meta-analyses, a statistically significant reduction in mortality or relevant adverse clinical outcomes amongst surgical or critically ill adult or paediatric patients has not been found with the use of any particular IV fluid.

Restrictive fluid regimens may decrease perioperative morbidity in adults undergoing elective intra-abdominal surgery but the results cannot be generalised to other populations or procedures. The effect of restricted versus liberal fluid regimens on clinical outcomes in patients undergoing minimally invasive or ambulatory procedures is still inconclusive.

Although there is a trend in fewer deaths with delayed fluid resuscitation of patients with penetrating trauma, the data are insufficient to draw guidelines. Large multicentre randomised controlled trials (RCTs) of fluid regimens with clinically relevant outcomes are still needed to address important questions in this field.

Introduction

The use of IV fluids for volume resuscitation and fluid replacement in the surgical or critically ill patient has been studied and practiced for nearly 90 years. Despite hundreds of laboratory and clinical studies, the choice of IV fluid, the volume of fluid to be administered, and the timing of fluid administration remain controversial.