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The ideal fluid

Russell, Lyndal; McLean, Anthony S.

Current Opinion in Critical Care: August 2014 - Volume 20 - Issue 4 - p 360–365
doi: 10.1097/MCC.0000000000000112
INTRAVENOUS FLUIDS: Edited by Greg S. Martin

Purpose of review The characteristics of an ideal intravenous fluid in the critically ill patient are discussed.

Recent findings Intravenous fluids are the most frequent drug administered to patients. Questioning the use of commonly administered intravenous fluids has resulted in an increased focus on their efficacy and safety. Discrimination between fluids currently in use has been the central theme of many recent large studies, and emerging from these findings is an understanding of characteristics that would make for an ideal fluid for critically ill patients. There is increased morbidity and mortality with high chloride-containing crystalloid solutions and hydroxyethyl starch preparations, with resultant international governmental agency warnings regarding hydroxyethyl starch . The ideal fluid is one which achieves the aim of administration while minimizing or negating adverse effects, is inexpensive, and sufficiently stable when stored to be used in a wide range of clinical settings.

Summary The ideal fluid currently does not exist. Of existing options, use of hydroxyethyl starches and high chloride-containing crystalloid solutions should be discouraged. There is a lack of direct evidence that a balanced crystalloid solution confers benefit, however, the trend of recent data would support future investigation into the advantage of balanced solution over 0.9% saline.

Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia

Correspondence to Professor Anthony S. McLean, C/- ICU Admin, Nepean Hospital, PO box 63, Penrith , NSW 2751, Australia. Tel: +61 (0) 2 4734 2490;

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins