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The study was actually stopped early when the intervention group that received the IV fluid bolus showed an increased mortality of 45 percent. While it is important to recognize the limitations of this study (most of the children presented with malaria, which may predispose the patients to harm from a fluid bolus, and the study was conducted in hospitals without ICU-level capabilities) the results are nonetheless both thought-provoking and unsettling.
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ACEP Now: Vol 41 – No 06 – June 2022Water, Water, Everywhere…
Despite their limitations, IV fluids are here to stay, but the next time you consider another bolus to determine whether or not your patient is “fluid-responsive,” perhaps you should take a step back and ask yourself if they actually instead need blood, vasopressors, or another intervention in the next step of their care. When it comes to fluid “resuscitation,” it turns out that less is indeed more.
Dr. Cunningham is a third-year emergency medicine resident at Maricopa Medical Center and soon-to-be critical care fellow at Stanford Medical Center in Standford, Calif.
References
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