What is the ideal IV fluid? (#iFADmini #IFAD2018)

What is the ideal IV fluid? (#iFADmini #IFAD2018)

Can we engineer a superfluid to replace human plasma?

Take Home message on the ideal fluid (lecture by @Manu_Malbrain #14ECCC #iFADmini Dubai):

    • The ideal IV fluid does not exist
      • Different fluids have different (contra)indication during the different phases
    • Resuscitation fluids should save lives: give them in appropriate dose and timing
      • 4ml/kg/10 minutes and repeat
      • Set your targets appropriately to reach your goals
      • Targets and goals are dynamic and can change during different phases
    • Maintenance fluids should cover daily needs
      • for water: 1ml/kg/hr
      • for glucose: 1 – 1.5 g/kg
      • for Sodium (Na): 1 – 1.5 mEq/kg
      • for Potassium (K): 0.5 – 1 mEq/kg
    • Replacement fluids should the fluids that were lost
      • Give saline or NH4Cl (multion gastrique) in case of GI losses
      • Give blood when bleeding
    • Fluids in sepsis and in general ICU patients
      • Never use starches (little evidence for gelatins)
      • Don’t use (abnormal) saline (NaCl 0.9%) or glucose 5% for resuscitation
      • You can use saline to dilute drugs (max 1ml/kg/first week)
      • Use (balanced) crystalloids for resuscitation
      • Consider albumin 20%, esp. in very sick septic patients at later stage and during de-resuscitation
      • Cover daily needs with…? Hypotonic solutions probably better than isotonic
    • Fluids in perioperative setting (+ trauma)
      • We can’t extrapolate from the big fluid trials and need dedicated studies, beyond fluid choice alone
      • Starches still could have their place, but… we are awaiting final EMEA decision on PRAC recommendation
        • In their dedicated setting: acute and proven hypovolemia
        • With great care (maximum dose 30ml/kg, not in AKI or CKI, not in sepsis or burns)
      • Gaps best to be filled by balanced crystalloids (not saline), little evidence for gelatins
      • More emphasis on fluid strategy than on the fluid itself
    • Implement Fluid Stewardship in your hospital and ICU
      • Start with snapshot
        • Check what you use (pharmacy)
        • Perform survey on knowledge (doctors and nurses)
        • Clinical audit (medical records and patient files)
      • PDCA cycle
        • Set-up guidance
        • Start teaching
        • Re-evaluation after 6 months

    • Link to Video on Vimeo: https://vimeo.com/263125026


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