JAMA · 2026
Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Blok Siebe G, de Grooth Harm-Jan, Pisani Luigi, Barbas Carmen, Chew Michelle, Dubin Arnaldo, Hammond Naomi, Kwizera Arthur, Malbrain Manu L N G, Monnet Xavier, Myatra Sheila N, Rose Louise, Neto Ary Serpa, Shi Zhonghua, Silversides Jonathan, Tripathy Swagata, van Haren Frank, Dondorp Arjen, Schultz Marcus J, van Regenmortel Niels, Paulus Frederique, Tuinman Pieter R, PRoFLUID Investigators
Аннотация
IMPORTANCE: Fluid therapy is ubiquitous in the intensive care unit (ICU) but carries risks, especially in mechanically ventilated patients. Contemporary global practice across dose, indication, and type is unknown.
OBJECTIVE: To characterize ICU fluid practices in mechanically ventilated adults.
DESIGN, SETTING, AND PARTICIPANTS: International prospective observational cohort study between April 2024 and July 2025, across 206 ICUs in 41 countries on 6 continents. Consecutive adult patients receiving invasive mechanical ventilation within 3 days of ICU admission and ventilated 24 hours or more. Exclusion criteria were age younger than 16 years and transfer under mechanical ventilation from another ICU.
EXPOSURES: Fluid volume, indication, and type after intubation.
MAIN OUTCOMES AND MEASURES: Key measures included (1) total infused volume and daily fluid balance over 7 days after intubation; (2) the indication for fluid therapy over the first 3 days after intubation; (3) the proportion of total administered fluid volume attributable to each fluid type over the first 3 days after intubation.
RESULTS: Among 2454 patients analyzed (median age, 63 years [IQR, 49-73 years]; 63.6% [1560] male), median daily fluid input peaked on day 1 at 3.0 L (IQR, 2.2-4.0 L) and declined to 2.6 L (IQR, 1.8-3.5 L) through day 6. Daily fluid balance (median, 0.9 L; IQR, 0.1-1.9 L on day 1) decreased to less than 0.3 L (IQR, -0.5 to 1.2 L) by day 3 and remained near-neutral through day 6. Maintenance and replacement fluids (to meet daily requirements and to correct ongoing losses; 31.9%) and creep fluids (to deliver medications and maintain catheter patency; 30.9%) were the primary indications, whereas resuscitation (to restore circulating blood volume; 16.0%) accounted for a smaller proportion. Isotonic balanced crystalloids (48.9%) and isotonic saline (0.9% sodium chloride) (27.0%) were common; colloids were rare (1.3%). Substantial between-site variation persisted after adjustment for case-mix.
CONCLUSIONS AND RELEVANCE: In this prospective international cohort study, fluid therapy varied widely among mechanically ventilated critically ill patients, with maintenance and creep fluids-rather than resuscitation fluids-accounting for most total volume.
OBJECTIVE: To characterize ICU fluid practices in mechanically ventilated adults.
DESIGN, SETTING, AND PARTICIPANTS: International prospective observational cohort study between April 2024 and July 2025, across 206 ICUs in 41 countries on 6 continents. Consecutive adult patients receiving invasive mechanical ventilation within 3 days of ICU admission and ventilated 24 hours or more. Exclusion criteria were age younger than 16 years and transfer under mechanical ventilation from another ICU.
EXPOSURES: Fluid volume, indication, and type after intubation.
MAIN OUTCOMES AND MEASURES: Key measures included (1) total infused volume and daily fluid balance over 7 days after intubation; (2) the indication for fluid therapy over the first 3 days after intubation; (3) the proportion of total administered fluid volume attributable to each fluid type over the first 3 days after intubation.
RESULTS: Among 2454 patients analyzed (median age, 63 years [IQR, 49-73 years]; 63.6% [1560] male), median daily fluid input peaked on day 1 at 3.0 L (IQR, 2.2-4.0 L) and declined to 2.6 L (IQR, 1.8-3.5 L) through day 6. Daily fluid balance (median, 0.9 L; IQR, 0.1-1.9 L on day 1) decreased to less than 0.3 L (IQR, -0.5 to 1.2 L) by day 3 and remained near-neutral through day 6. Maintenance and replacement fluids (to meet daily requirements and to correct ongoing losses; 31.9%) and creep fluids (to deliver medications and maintain catheter patency; 30.9%) were the primary indications, whereas resuscitation (to restore circulating blood volume; 16.0%) accounted for a smaller proportion. Isotonic balanced crystalloids (48.9%) and isotonic saline (0.9% sodium chloride) (27.0%) were common; colloids were rare (1.3%). Substantial between-site variation persisted after adjustment for case-mix.
CONCLUSIONS AND RELEVANCE: In this prospective international cohort study, fluid therapy varied widely among mechanically ventilated critically ill patients, with maintenance and creep fluids-rather than resuscitation fluids-accounting for most total volume.