Abstract
Background
Recent studies suggest that balanced fluids improve inpatient outcomes compared to
normal saline. The objective of this study was to obtain insights into clinicians’
knowledge, attitudes and perceived prescribing practices concerning IV isotonic fluids
and to analyze perceived prescribing in the context of actual prescribing.
Methods
This study, conducted at a single center (Medical University of South Carolina), included
1) a cross-sectional survey of physicians and advanced practice providers (APPs) (7/2019-8/2019)
and 2) review electronic health record (EHR) claims data (2/2018-1/2019) to quantify
the prescribing patterns of isotonic fluids.
Results
Clinicians perceived ordering equivalent amounts of normal saline and balanced fluids
although normal saline ordering predominated (59.7%). There was significant variation
in perceived and actual ordering across specialties, with internal medicine/subspecialty
and emergency medicine clinicians reporting preferential use of normal saline and
surgical/subspecialty and anesthesia clinicians reporting preferential use of balanced
fluids (p < 0.0001). Clinicians who self-reported providing care in an intensive care
unit (ICU) reported more frequent use of balanced fluids than non-ICU clinicians (p = 0.03). Actual prescribing data mirrored these differences. Clinicians’ self-reported
use of continuous infusions (p = 0.0006) and beliefs regarding the volume of fluid required to cause harm (p = 0.003) were also associated with self-reported differences in fluid prescribing.
Clinician experience, most clinical considerations (e.g., indications, contraindications,
barriers to using a specific fluid), and fluid cost were not associated with differential
prescribing.
Conclusions
Persistent normal saline utilization is associated with certain specialties, care
locations, and the rate and volume of fluid administered, but not with other clinical
considerations or cost. These findings can guide interventions to improve evidence-based
fluid prescribing.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The complexities of intravenous fluid research: questions of scale, volume, and accumulation.Korean J Crit Care Med. 2016; 31: 276-299
2017 AHA Annual Survey 2022
- Choice of fluid type: physiological concepts and perioperative indications.Br J Anaesth. 2018; 120: 384-396
- Safety through education. FY1 doctors still poor in prescribing intravenous fluids.BMJ. 2011; 342: d2741
- Problems with solutions: drowning in the brine of an inadequate knowledge base.Clin Nutr. 2001; 20: 125-130
- Fluid and electrolyte balance-establishing the knowledge base of Foundation Year One doctors.Ir J Med Sci. 2019; 188: 1047-1055
- Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement.BMC Medical Educ. 2014; 14: 35
- Textbook coverage of a common topic: fluid management of patients after surgery.Med Educ. 2008; 42: 613-618
- Learning fluid prescription skills: why is it so challenging?.Clin Teach. 2015; 12: 250-254
- Variability in the prescribing of intravenous fluids: a cross sectional multicentre analysis of clinical practice.Int J Surg. 2018; 51: 199-204
- Risks of intravenous fluid therapy by first year residents—a prospective study.Br J Med Med Res. 2016; 15: 1-13
- Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study.PLoS ONE. 2017; 12e0176292
- Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units.Crit Care. 2010; 14: R185
- Choices in fluid type and volume during resuscitation: impact on patient outcomes.Ann Intensive Care. 2014; 4: 38
- Balanced crystalloids versus saline in critically ill adults.N Engl J Med. 2018; 378: 829-839
- Balanced crystalloids versus saline in noncritically ill adults.N Engl J Med. 2018; 378: 819-828
- Balanced crystalloids versus saline in sepsis: a secondary analysis of the SMART trial.Am J Respir Crit Care Med. 2019;
- The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.PLoS Med. 2015; 12 (Published 2015 Oct 6)e1001885https://doi.org/10.1371/journal.pmed.1001885
- Designing and Conducting Health Surveys, A Comprehensive Guide.John Wiley & Sons, 2011
- Exploring physician specialist response rates to web-based surveys.BMC Med Res Methodol. 2015; 15: 32
- Physician response to surveys. A review of the literature.Am J Prev Med. 2001; 20: 61-67
- Collapsing categories is often more advantageous than modeling sparse data: investigations in the CFA framework.Struct Equ Model. 2020; : 1-13
- A randomized, double-blind comparison of lactated Ringer's solution and 0.9% NaCl during renal transplantation.Anesth Analg. 2005; 100: 1518-1524
- Effects of normal saline vs. lactated ringer's during renal transplantation.Ren Fail. 2008; 30: 535-539
- A comparative study of impact of infusion of Ringer's Lactate solution versus normal saline on acid-base balance and serum electrolytes during live related renal transplantation.Saudi J Kidney Dis Transpl. 2012; 23: 135-137
- Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial.Br J Anaesth. 2017; 119: 606-615
- British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP).NHS National Library of Health, London2011
- Intravenous Fluid Therapy in Adults: Clinical Guideline.National Institute for Health and Care Excellence, London2013
- Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS Randomized Clinical Trial.JAMA. 2021; 326: 1-12
Article info
Publication history
Published online: April 03, 2022
Accepted:
March 29,
2022
Received:
January 12,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
