Time to further investigate the drip: it's clear we need a better solution to fluid usage in critical care

Factors around fluid usage in critical care are under the spotlight, in a review article led by The George Institute for Global Health’s Director of Critical Care and Trauma, Professor John Myburgh AO, published in The New England Journal of Medicine.

The article reviews the make-up of fluid resuscitation, associated health risks and limitations around available options.

Critical Care researcher at The George Institute and Intensive Care Physician at St George Hospital, Manoj Saxena, said: "Just about every emergency patient admitted to hospital will need fluids administered quickly. Our research has shown that saline fluid, in general, is the cheapest, most commonly used fluid-type and is equally as effective, as well as being safer than the more costly colloid (both albumin and starch-based) solutions.

“The body of work from The George Institute in Australia and New Zealand has contributed to the change in the way the medical world thinks about fluids. Prior to our research, it was generally thought the type and volume of fluid didn’t matter a great deal,” Dr Saxena said.

“However, research in this area has already revealed a higher incidence of kidney injury when critically ill patients are administered starch dominant fluids – which we suspect are still being used in some Australian hospitals and, prior to our study, were the dominant fluid used around the globe.

“In Australia and globally, the regulatory authorities are assessing and making recommendations based on this new information. We also are beginning to ask questions to define the ideal fluid type.

“Given resuscitation fluids are used so commonly in intensive care units, operating theatres, emergency departments and in general wards, a greater focus needs to be placed on both the safety and efficacy of what is being administered. We should actually treat fluids with the same care as the prescription of a drug.”

Dr Saxena outlined some of the upcoming projects that will assess usage of fluids and the potential for a better solution.

“Our next steps are to embark on three different research studies to answer some of the unknowns. We will be looking at current fluid usage in Australian healthcare and abroad, reviewing how and why fluids are given, and also investigating the possibility of a safer, more effective solution than those in current use,” Dr Saxena said.

The review article is available here

Leads

• Professor John Myburgh AO

  Director, Professoriate