Reanimación con fluidos: perspectiva actual

Update on fluid therapy in the critical patient resuscitation process

The administration of fluids for the resuscitation of the seriously ill patient in intensive care units is one of the most frequent interventions. Up to 40% of the time it is the nursing team that makes the decision to administer a fluid bolus to a critically ill patient according to established protocols. Therefore we perform a review in this paper of the current status of fluid therapy and its use in this type of patient. In order to optimize the knowledge and the treatment administered to this type of patient, we also describe the different types of fluids currently used and possible adverse effects that may develop after their administration.

Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II

OBJECTIVE

To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU.

PATIENTS AND METHODS

Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid).

RESULTS

We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92).

CONCLUSIONS

The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia.