Written by Aaron Lacy
?Why does this matter
In patients with poor perfusion, fluids are a mainstay of treatment. While boluses of fluid are normally given to these patients, there is little literature to guide how fast the fluid should be delivered. If there is a difference in outcomes based on rate of infusion, this would be a simple step to take to better serve our patients.
‘Slow and Steady?’ or ‘The Need for Speed’
The Balanced Solutions in Intensive Care Study (BaSICS) was a double-blind, randomized clinical trial in 75 ICUs in Brazil with over 10,000 adult patients participating. The two intervention arms were looking at both fluid infusion speed (333ml/hr and 999ml/hr) and fluid type (PlasmaLyte vs NS), which we will cover tomorrow. The primary outcome, 90-day mortality, was 26.6% in the slower infusion rate and 27.0% in the faster infusion rate group (aHR, 1.03; 95% CI, 0.96-1.11; P=.46). A secondary outcome, need for renal replacement therapy within 90 days or doubling of the creatine, was also not statistically significant (27.8% balanced crystalloids vs 28.9% NS, 95% CI, 0.86-1.04). There was no association with type of fluid and rate on any patient outcome.
There has been a lot of attention of late in the literature on type of fluid given, but there are other variables to giving fluids than just the type: volume, temperature, and timing of administration could all play a roll. This study, in some part, sought to answer the question of whether fluid rate made a difference, and for their population it did not. While this study is ICU based and I practice in the pre-hospital and ED setting, it is reassuring for my current practice – which is in patients without adequate perfusion to get the fluids in as fast as possible.
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