The online version of this article (doi:10.1186/cc9293) contains supplementary material, which is available to authorized users.
CSL Ltd. partially funded the original SAFE Study and has refunded travel expenses incurred by SF and RB in presenting the results at industry sponsored and academic meetings. Fresenius Kabi has refunded travel expenses incurred by SF and JM in attending meetings to discuss research into the clinical effects of hydroxyethyl starches in critically ill patients. Fresenius Kabi has provided an unrestricted research grant to the University of Sydney for the conduct of a fluid resuscitation trial for which JM is the chief investigator. BL owns shares in CSL Ltd. BD has received speaker fees from B. Braun Medical (Shanghai) Co., Ltd, and Beijing Frensius Kabi Pharmaceutical Co., Ltd. CT, LB, CM and DC have no competing interests.
SF conceived the study, supervised the design and conduct, and helped to draft the manuscript. BL contributed to the data analysis plan, conducted analyses and drafted the manuscript. CT co-ordinated and managed the study, contributed to the data analysis plan and helped to draft the manuscript. RB, DC, CM and JM contributed to study design and supervised the conduct of the study. LB advised on and supervised the data analysis plan. All authors critically reviewed the manuscript for important intellectual content and approved the final manuscript.
Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients.
We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products).
During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score).
Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.
Additional file 1:Data collection forms: Case report form and other data collection forms used in The SAFE TRIPS Study. (DOCX 58 KB)13054_2010_8786_MOESM1_ESM.DOCX
Additional file 2:Hierarchy for indications: Hierarchy of indications for administration of resuscitation fluid. Were more than one indication was given the indication highest on the hierarchy was taken to be the main indication. (DOCX 13 KB)13054_2010_8786_MOESM2_ESM.DOCX
Additional file 3:The SAFE TRIPS Investigators: Listing of all SAFE TRIPS investigators by country and institution. (DOCX 26 KB)13054_2010_8786_MOESM3_ESM.DOCX
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- Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units
SAFE TRIPS Investigators
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