[Application and control of intravenous fluids in German intensive care units : A national survey among critical care physicians].

Die Anaesthesiologie Pub Date : 2024-02-01 Epub Date: 2024-01-30 DOI:10.1007/s00101-024-01379-4
J Porth, J Ajouri, M Kleinlein, M Höckel, G Elke, P Meybohm, C Culmsee, R M Muellenbach
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Abstract

Background: The administration of intravenous fluids includes various indications, e.g., fluid replacement, nutritional therapy or as a solvent for drugs and is a common routine in the intensive care unit (ICU); however, overuse of intravenous fluids can lead to fluid overload, which can be associated with a poorer outcome in critically ill patients.

Objective: The aim of this survey was to find out the current status of the use and management of intravenous fluids as well as the interprofessional cooperation involving clinical pharmacists on German ICUs.

Methods: An online survey with 33 questions was developed. The answers of 62 participants from the Scientific Working Group on Intensive Care Medicine of the German Society for Anesthesiology and Intensive Care Medicine were evaluated.

Results: Fluid overload occurs "frequently" in 62.9% (39/62) and "very frequently" in 9.7% (6/62) of the ICUs of respondents. An established standard for an infusion management system is unknown to 71.0% (44/62) of participants and 45.2% of the respondents stated that they did not have a patient data management system. In addition, the participants indicated how they define fluid overload. This was defined by the presence of edema by 50.9% (28/55) and by positive fluid balance by 30.9% (17/55). According to the participants septic patients (38/60; 63.3%) and cardiological/cardiac surgical patients (26/60; 43.3%) are most susceptible to the occurrence of fluid overload. Interprofessional collaboration among intensive care physicians, critical care nurses, and clinical pharmacists to optimize fluid therapy was described as "relevant" by 38.7% (24/62) and "very relevant" by 45.2% (28/62). Participants with clinical pharmacists on the wards (24/62; 38.7%) answered this question more often as "very relevant" with 62.5% (15/24).

Conclusion: Fluid overload is a frequent and relevant problem in German intensive care units. Yet there are few established standards in this area. There is also a lack of validated diagnostic parameters and a clear definition of fluid overload. These are required to ensure appropriate and effective treatment that is tailored to the patient and adapted to the respective situation. Intravenous fluids should be considered as drugs that may exert side effects or can be overdosed with severe adverse consequences for the patients. One approach to optimize fluid therapy could be achieved by a fluid stewardship corresponding to comparable established procedures of the antibiotic stewardship. In particular, fluid stewardship will contribute to drug safety of intravenous fluids profiting from joined expertise in a setting of interprofessional collaboration. An important principle of fluid stewardship is to consider intravenous fluids in the same way as medication in terms of their importance. Furthermore, more in-depth studies are needed to investigate the effects of interprofessional fluid stewardship in a prospective and controlled manner.

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[德国重症监护病房静脉输液的应用与控制 :重症监护医生全国调查]。
背景:静脉输液有多种用途,如补充体液、营养治疗或作为药物的溶剂,是重症监护病房(ICU)的常见常规操作;然而,过度使用静脉输液会导致体液超负荷,从而导致重症患者的预后较差:本调查旨在了解德国重症监护病房静脉输液的使用和管理现状,以及临床药剂师参与的跨专业合作情况:方法:制定了一项包含 33 个问题的在线调查。对来自德国麻醉学和重症医学会重症医学科学工作组的 62 名参与者的回答进行了评估:结果显示:62.9%(39/62)的受访重症监护病房 "经常 "出现液体超负荷,9.7%(6/62)的受访重症监护病房 "非常经常 "出现液体超负荷。71.0%(44/62)的受访者不知道输液管理系统的既定标准,45.2%的受访者表示他们没有患者数据管理系统。此外,参与者还说明了他们如何定义液体超负荷。50.9%的受访者(28/55)认为是水肿,30.9%的受访者(17/55)认为是体液正平衡。与会者认为,脓毒症患者(38/60;63.3%)和心脏病/心脏手术患者(26/60;43.3%)最容易出现体液超负荷。38.7%(24/62)和 45.2%(28/62)的参与者认为重症监护医生、重症监护护士和临床药剂师之间的跨专业合作与优化液体疗法 "相关","非常相关"。有临床药剂师在病房工作的参与者(24/62;38.7%)对此问题的回答多为 "非常相关",占 62.5%(15/24):结论:液体超负荷是德国重症监护病房经常出现的相关问题。结论:体液超负荷是德国重症监护病房经常遇到的相关问题,但该领域几乎没有既定的标准。此外,还缺乏有效的诊断参数和明确的液体超负荷定义。要确保根据患者的具体情况进行适当而有效的治疗,这些都是必不可少的。静脉输液应被视为药物,可能会产生副作用,也可能因用药过量而对患者造成严重不良后果。优化输液治疗的一种方法是采用与抗生素管理的既定程序相对应的输液管理方法。特别是,在跨专业合作的背景下,输液管理将从加入的专业知识中获益,从而促进静脉输液的用药安全。输液管理的一项重要原则是将静脉输液与药物同等对待。此外,还需要进行更深入的研究,以前瞻性和可控的方式调查跨专业输液管理的效果。
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