Slower IV fluid infusion does not reduce 90-day mortality in ICU patients: JAMA

Brazil: Slower intravenous fluid infusion rates compared to faster rates did not reduce 90-day mortality in critically ill patients, according to a recent study in the Journal of American Medical Association (JAMA). 

Previous studies have shown slower intravenous fluid infusion rates to minimize tissue edema and organ dysfunction in critically sick patients; however, there is little evidence to support differing infusion rates during fluid challenges for crucial outcomes like death.

Researchers from Brazil wanted to check how a slower infusion rate compared to a control infusion rate affected 90-day survival in patients in the critical care unit (ICU).

From 29 May 2017 to 02 March 2020, 10,520 patients requiring at least one fluid challenge and with one risk factor for poor outcomes were grouped in a factorial clinical study in 75 ICUs in Brazil. On October 29, 2020, the follow-up was completed. Patients were randomly assigned to one of two infusion rates (described in this article) and one of two fluid types (balanced fluids or saline, reported separately).

The slower rate group received a mean of 1162 mL on the first day while the control group received 1252 mL. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died, compared to 1414 of 5244 (27.0%) in the control group. The interaction between fluid type and infusion rate showed no statistically significant data.

In conclusion, Fernando G. Zampier wrote that infusing intravenous fluids at a slower pace vs a quicker rate did not reduce 90-day mortality in patients in the intensive care unit who had fluid challenges. These data contradict the use of a reduced infusion rate.

The findings in this study "Effect of Slower Vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial," were published online in the JAMA Network on 10.08.2021.

For further reading

Zampieri FG, Machado FR, Biondi RS, et al. Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA. Published online August 10, 2021. doi:10.1001/jama.2021.11444