Description
Intravenous fluid therapy is one of the most significant and common interventions in acutely and critically ill patients. The main indications are resuscitation, replacement and maintenance. The administration of Crystalloid fluids or Intravenous fluid therapy is mostly used as first-line therapy in most of the life threatening conditions like sepsis, cirrhosis or infections.
Summary Listen
- Intravenous fluid administration, a common practice in acute and critical care, lacks robust efficacy investigations despite its established clinical use. Historically, a liberal approach prevailed due to beliefs about dehydration and edema, but now it's recognized that fluids are drugs requiring careful consideration. Practitioners are increasingly prioritizing impaired tissue perfusion and low cardiac output over mere abnormal vital signs as indications for fluid administration.
- Fluid management follows a "four Bs" framework: bolus (fluid type), best (dose), but (duration), and be-aware (patient). Similarly, fluid therapy is approached using phased strategies like SOSD (salvage, optimization, stabilization, de-escalation) or ROSE (resuscitation, optimization, stabilization, evacuation). The ROSE method is generally preferred and focuses on life-saving resuscitation, organ rescue, organ support, and fluid overload resolution.
- Resuscitation involves rapid fluid boluses to correct shock and achieve adequate tissue perfusion. Optimization aims to maintain tissue perfusion and oxygenation, preventing organ damage. Stabilization focuses on replacing ongoing losses with a zero or slightly negative fluid balance. Evacuation removes excess fluid, often achieved spontaneously but sometimes requiring diuretics or ultrafiltration.
- Crystalloids and colloids are the primary fluid types. Balanced salt solutions, though more expensive, are considered more physiological than normal saline. Albumin can benefit specific patients, but synthetic colloids like hydroxy starch and gelatin should be avoided due to safety concerns.
- The "five Ps" of fluid management (physician, prescription, pharmacy, preparation, patient) mirror antibiotic stewardship, emphasizing appropriate fluid prescription, pharmacist checks, and sterile fluid administration. Neutral or negative fluid balance is preferred at the end of resuscitation, before oral intake resumes. The key is to administer the right fluid, in the right dose, to the right patient, at the right time.
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About the Speakers
Dr Atchyuth R Gongada
HoD and Sr Consultant Dept of Critical Care & Anaesthesiology Apollo Hospitals, Healtcity, Visakhapatnam
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