Maintenance fluid practices in intensive care units in Australia and New Zealand.

BACKGROUND: Administration of maintenance fluid is common practice in the intensive care unit, contributing to daily fluid and sodium intake and balance. Despite this, there is little evidence to describe clinical practices relating to its administration to ICU patients. METHODS: We conducted a prospective, observational, point-prevalence study in 49 Australian and New Zealand ICUs in 2014. We aimed to document the type and volume of maintenance fluid administered to ICU patients, and to describe additional fluid received. We also assessed changes in maintenance fluid administration practices compared with our similar study conducted in 2011. RESULTS: Of 645 patients enrolled, 399 (62%) received maintenance fluid on the study day. A median volume of 630 mL (interquartile range [IQR], 272-1250 mL) was delivered, accounting for a median of 35% (IQR, 16%- 56%) of total daily administered fluids. This was in addition to other fluids administered as fluid resuscitation, drug infusions and boluses, flushes and enteral or parenteral feeds, as well as oral intake. 0.9% saline was the most commonly used maintenance fluid (36%), followed by balanced salt solutions (30%). Compared with data from 2011, there has been a decrease in the median volume of maintenance fluid administered (2011, 860 mL [IQR, 360- 1533 mL]; 2014, 630 mL [IQR, 287-1328 mL]; P = 0.01), although the proportion of patients receiving maintenance fluid remains unchanged. There has been no change in the types of fluids most commonly used for maintenance, but the use of balanced salt solutions has increased (2011, 24%; 2014, 30%; P = 0.01). CONCLUSION: Administration of maintenance fluids to patients in Australian and New Zealand ICUs is common. Although the volume being delivered has decreased, maintenance fluids contribute over one-third of daily total fluid administration.

A multicentre audit of temperature patterns after traumatic brain injury.

BACKGROUND: Elevation of body temperature is common after traumatic brain injury (TBI). Suppressing fever may be beneficial. HYPOTHESIS: In clinical practice, temperature is maintained _37°C. PARTICIPANTS, SETTING AND METHODS: A retrospective, multicentre, cohort study of patients with an intensive care unit admission diagnosis of TBI over a 6-month period. MAIN OUTCOME MEASURES: The mean proportion of time per day that temperature _37°C or _38°C (to correct for unequal measurements between patients, imputation was used between consecutive temperature measurements and a linear relationship was assumed); and the proportion of patients on each day with a peak temperature _37°C. RESULTS: 217 patients with TBI were admitted to eight ICUs. The mean Acute Physiology and Chronic Health Evaluation II score of the cohort was 15.7 (SD, 7.7) and intracranial pressure monitoring was done in 29% of patients. The mean proportion of time on each day that temperature was _37°C varied between 56% (SE, 2.6%) on Day 1 and 89% (SE, 3.7%) on Day 14. The mean proportion of time per day that temperature was > 38°C was between a minimum of 11% (SE, 1.5%) on Day 1 and a maximum of 25% (SE, 4.4%) Day 11. The proportion of patients for whom daily peak temperature was > 37°C ranged between a minimum of 73.2% (153/209) on Day 1 and a maximum of 97.4% (26/33) on Day 13. CONCLUSION: In patients with TBI, a substantial proportion of time is spent with a temperature _37°C. Prospective validation of these data are required.