Fluids are Drugs (#ISICEM18 #IFAD2018)
It is time to consider the 4 D's of fluid therapy
In analogy to antibiotic stewardship physicians should treat fluids also as drugs
THE FOUR D’s OF FLUID THERAPY
In analogy with antibiotic therapy, we must take into account the compounds, the pharmocodynamic and pharmakokinetic properties of different fluids and should consider the "four D’s" of fluid therapy when treating patients with septic shock: drug, dosing, duration, and de-escalation.
THE FOUR INDICATIONS OF FLUID THERAPY
There are only 4 indications to give IV Fluids: for resuscitation, for maintenance, for replacement and finally for nutrition.
THE 4 QUESTIONS OF FLUID THERAPY
Whilst administering IV Fluids always take into account the 4 questions: First, when to start IV Fluids (benefits of fluids), Next, when to stop IV Fluids (risks of fluids), Third, when to start fluid removal (the benefits of de-resuscitation), and Finally, when to stop de-resuscitation (to avoid hypoperfusion)
THE 4 PHASES OF FLUID THERAPY
Clinicians should be ware of the 4 phases of fluid theraoy. First comes Resuscitation, this is about to save lives. Next optiization and organ support. Third phase is stabilization and finally comes evacuation (or de-resuscitation).
Take home messages
- Answer the 4 questions
- Check the 4 indications
- Consider the 4 D’s
- Don’t forget 4 phases (ROSE)
Treat fluids as drugs (4 D's)
- Treat Fluids as Drugs: Check for (Contra-)indications and be aware they may have adverse effects
- Fluid Dose: It is all about the correct Timing, initial dose, speed, cumulative dose
- Duration: Stop IV Fluids when no longer fluid responsive. Use dynamic preload and fluid responsiveness indices, PLR, EEO
- De-escalation whenever possible: De-resuscitation if fluid overload (FO) as FO causes increased morbidity/mortality
In this lecture given by @manu_malbrain during the 38th #ISICEM18 meeting held in Brussels the above mentioned concepts will be explained and discussed.
Why wait, just start with fluid stewardship now:
- Start with a snapshot: Check what you use (pharmacy) - Perform survey on knowledge (doctors) - Perform Clinical audit (files)
- PDCA cycle: Set-up guidance - Start Teaching - perform Re-evaluation
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