Fluid resuscitation practice patterns in intensive care units of the USA: a cross-sectional survey of critical care physicians.

Miller, Timothy E

Bunke, Martin

Nisbet, Paul

Brudney, Charles S

England

2016-08-01T16:41:14Z

2016

BACKGROUND: Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Therefore, our goal was to investigate the practice patterns of fluid utilization for resuscitation of adult patients in intensive care units (ICUs) within the USA. METHODS: We conducted a cross-sectional online survey of 502 physicians practicing in medical and surgical ICUs. Survey questions were designed to assess clinical decision-making processes for 3 types of patients who need volume expansion: (1) not bleeding and not septic, (2) bleeding but not septic, (3) requiring resuscitation for sepsis. First-choice fluid used in fluid boluses for these 3 patient types was requested from the respondents. Descriptive statistics were performed using a Kruskal-Wallis test to evaluate differences among the physician groups. Follow-up tests, including t tests, were conducted to evaluate differences between ICU types, hospital settings, and bolus volume. RESULTS: Fluid resuscitation varied with respect to preferences for the factors to determine volume status and preferences for fluid types. The 3 most frequently preferred volume indicators were blood pressure, urine output, and central venous pressure. Regardless of the patient type, the most preferred fluid type was crystalloid, followed by 5 % albumin and then 6 % hydroxyethyl starches (HES) 450/0.70 and 6 % HES 600/0.75. Surprisingly, up to 10 % of physicians still chose HES as the first choice of fluid for resuscitation in sepsis. The clinical specialty and the practice setting of the treating physicians also influenced fluid choices. CONCLUSIONS: Practice patterns of fluid resuscitation varied in the USA, depending on patient characteristics, clinical specialties, and practice settings of the treating physicians.

http://www.ncbi.nlm.nih.gov/pubmed/27313844

35

https://hdl.handle.net/10161/12551

eng

Springer Science and Business Media LLC

Perioper Med (Lond)

10.1186/s13741-016-0035-2

Albumin

Bleeding

Colloids

Crystalloids

Fluid resuscitation

Intensive care unit

Sepsis

Survey

Fluid resuscitation practice patterns in intensive care units of the USA: a cross-sectional survey of critical care physicians.

Journal article

Miller, Timothy E|0000-0001-8567-6680

http://www.ncbi.nlm.nih.gov/pubmed/27313844

15

Anesthesiology

Anesthesiology, General, Vascular, High Risk Transplant & Critical Care

Clinical Science Departments

Duke

School of Medicine

Published online

5