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Impact of intravenous fluid composition on outcomes in patients with systemic inflammatory response syndrome

Shaw, Andrew D.; Schermer, Carol R.; Lobo, Dileep N.; Munson, Sibyl H.; Khangulov, Victor; Hayashida, David K.; Kellum, John A.

Authors

Andrew D. Shaw

Carol R. Schermer

DILEEP LOBO dileep.lobo@nottingham.ac.uk
Professor of Gastrointestinal Surgery

Sibyl H. Munson

Victor Khangulov

David K. Hayashida

John A. Kellum



Abstract

Introduction: Intravenous (IV) fluids may be associated with complications not often attributed to fluid type. Fluids with high chloride concentrations such as 0.9 % saline have been associated with adverse outcomes in surgery and critical care. Understanding the association between fluid type and outcomes in general hospitalized patients may inform selection of fluid type in clinical practice. We sought to determine if the type of IV fluid administered to patients with systemic inflammatory response syndrome (SIRS) is associated with outcome.

Methods: This was a propensity-matched cohort study in hospitalized patients receiving at least 500 mL IV crystalloid within 48 hours of SIRS. Patient data was extracted from a large multi-hospital electronic health record database between January 1, 2009, and March 31, 2013. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, readmission, and complications measured by ICD-9 coding and clinical definitions. Outcomes were adjusted for illness severity using the Acute Physiology Score. Of the 91,069 patients meeting inclusion criteria, 89,363 (98 %) received 0.9 % saline whereas 1706 (2 %) received a calcium-free balanced solution as the primary fluid.

Results: There were 3116 well-matched patients, 1558 in each cohort. In comparison with the calcium-free balanced cohort, the saline cohort experienced greater in-hospital mortality (3.27 % vs. 1.03 %, P

Journal Article Type Article
Publication Date Sep 12, 2015
Journal Critical Care
Print ISSN 1574-4280
Electronic ISSN 1466-609X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Article Number 334
APA6 Citation Shaw, A. D., Schermer, C. R., Lobo, D. N., Munson, S. H., Khangulov, V., Hayashida, D. K., & Kellum, J. A. (2015). Impact of intravenous fluid composition on outcomes in patients with systemic inflammatory response syndrome. Critical Care, 19, https://doi.org/10.1186/s13054-015-1045-z
DOI https://doi.org/10.1186/s13054-015-1045-z
Publisher URL https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-1045-z
Related Public URLs https://creativecommons.org/licenses/by/4.0/
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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