Mr. Haller
Clinical question: Is there a difference in the 90-day mortality for patients admitted to the ICU receiving a fast (999 mL/hour) versus slow (333 mL/hour) IV infusion rate?
Background: IV fluid resuscitation is the standard of care for patients who are critically ill with signs of shock. IV fluids given at a high rate are thought to improve the mean arterial pressure and cardiac output more quickly than those given at a slow rate. However, IV fluids given at a high rate may also lead to more fluid entering the tissues, resulting in worsening edema and even organ failure. Current guidelines continue to recommend IV fluid resuscitation for critically ill patients, but there is no consensus on the optimal infusion rate in this patient population.
Study design: Randomized clinical trial
Setting: 75 ICUs in Brazil from May 29, 2017, to March 2, 2020
Synopsis: Inclusion criteria included any patient requiring the ICU needing at least one fluid challenge, who were not discharging the next day, and who met at least one of the following criteria: age >65 years, hypotension, sepsis, use of mechanical ventilation, noninvasive mechanical ventilation or high flow nasal cannula, early signs of acute kidney injury, liver cirrhosis, or acute liver failure. 10,520 patients were available for analysis with 5,276 patients in the slow infusion (333 mL/hour) group and 5,244 patients in the fast infusion (999 mL/hour) group. Patient characteristics were similar, as was the median sequential organ failure assessment score between the groups (4, interquartile range, 2-6; and 4, interquartile range, 2-7). The mean volume infused as boluses on day one was 1,162 + 916 mL for the slow infusion group and 1,252 + 1009 mL for the fast infusion group. 26.6% of patients in the slow infusion group died by day 90 compared with 27.0% in the fast infusion group (HR, 1.03; 95% CI: 0.96-1.11; P =0.46).
Bottom Line: Infusing IV fluids at a slow rate compared to a fast rate did not change the 90-day mortality for ICU patients. However, more studies need to be conducted comparing different rates and their effects on mortality in this population.
Citation: Zampieri FG, et al. Effect of slower vs faster intravenous fluid bolus rates on mortality in critically ill patients: The BaSICS randomized clinical trial. JAMA. 2021;326(9):830-838. doi:10.1001/jama.2021.11444
Mr. Haller is a physician assistant at Atrium Health Wake Forest Baptist, Winston-Salem, N.C.