Intravenous fluid therapy is one of the most common interventions in patients with acute illnesses. More than 20% of patients in the intensive care unit receive intravenous resuscitation every day, and more than 30% get resuscitation using fluid on the first day of the intensive care unit. Almost all hospitalized patients receive intravenous fluid to maintain fluid delivery and as a diluent for drug administration. Until recently, the amount and type of fluids injected was based on a theory more than 100 years ago, much of which was incompatible with current physiological data and new data. Despite their widespread use, various intravenous fluids have entered clinical practice without a reliable assessment of their safety and efficacy. High-quality studies initiated by studies have shown that some of these fluids have unacceptable toxicity. As a result, some of them were withdrawn from the market (while others are still used in disputes). The suggestion that dehydration and hypovolemia can cause or exacerbate damage to the kidneys and other vital organs has led to liberal approaches to fluid therapy and to the fact that fluid overload and tissue swelling are “normal” in serious diseases. It may harm the patient. Increasing evidence suggests that restrictive fluid strategies can improve results.
Important points:
Intravenous fluid administration is one of the most common procedures in emergency and intensive care, but most of the underlying physiological theory is wrong.
Intravenous fluids were created in clinical practice and licensed for use without a thorough assessment of their efficacy or safety, although large, high-quality studies initiated by researchers now provide such data.
Crystalloid fluids should be used for first line therapy. In most patients, buffered saline solutions appear to have advantages over regular saline.
Albumin administration may be beneficial in patients with sepsis, cirrhosis, or infection, but albumin in a hypotonic carrier fluid is contraindicated in patients with acute traumatic brain injury.
Synthetic colloids, especially hydroxyethyl starch and gelatins, should not be used because of their unacceptable safety profile and lack of proven advantages over crystalloids.
Fluid restriction strategies can reduce morbidity and mortality. However, even more extensive studies are needed to confirm this promising baseline data.