Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units.
BACKGROUND
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.
Critical Care and Trauma Division, The George Institute for International Health, PO Box M201, Missenden Road, NSW 2050, Australia. sfinfer@george.org.au
Simon
S
Finfer
Bette
B
Liu
Colman
C
Taylor
Rinaldo
R
Bellomo
Laurent
L
Billot
Deborah
D
Cook
Bin
B
Du
Colin
C
McArthur
John
J
Myburgh
D000328:Adult; D000368:Aged; D003102:Colloids / Q000627:therapeutic use; D016638:Critical Illness; D003430:Cross-Sectional Studies; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D038622:Internationality; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods / Q000706:statistics & numerical data*
D003102:Colloids