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Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients

2021; American Medical Association; Volume: 326; Issue: 9 Linguagem: Inglês

10.1001/jama.2021.11444

1538-3598

Fernando G. Zampieri, Flávia Ribeiro Machado, Rodrigo Biondi, F Freitas, Viviane Cordeiro Veiga, Rodrigo C. Figueiredo, Wilson José Lovato, Cristina Prata Amêndola, Murillo Santucci César de Assunção, Ary Serpa Neto, Jorge L. R. Paranhos, José Andrade, Michele Maria Gonçalves de Godoy, Edson Romano, Felipe Dal‐Pizzol, Emerson Barbosa da Silva, Miquéias M.L. Silva, Miriam Machado, Luíz Marcelo Sá Malbouisson, Airton L. O. Manoel, Marlus M. Thompson, Lanese Medeiros de Figueiredo, Rafael Marques Soares, Tamiris Abait Miranda, Lucas M. de Lima, Eliana Vieira Santucci, Thiago Domingos Corrêa, Luciano César Pontes Azevedo, John A. Kellum, Lucas Petri Damiani, Nilton B. Silva, Alexandre Biasi Cavalcanti, Rodrigo Biondi, Bruno C. R. Amaral, Edvar Ferreira R., Andrea Z. Abdalla, Flávio Geraldo Rezende Freitas, Nathaly Fonseca Nunes, Rodrigo C. da Cunha, Elijane F. Alves, Rodrigo C. Figueiredo, Rodrigo B. Bortolini, Cintia L. Sartori, Eduardo S. Marques, Maria Auxiliadora de Sousa, Danieri Y. V. Tomotani, Airton L. O. Manoel, Wilson José Lovato, Bruno G. Dantas, Leonardo Carvalho Palma, Fabio Laurindo Silva, Cristina Prata Amêndola, Luciana Coelho Sanches, Fernanda A. M. Scuoteguazza, Ligia Z. de Britto, Ary Serpa, Niklas Söderberg Campos, Fábio Barlem Hohmann, Guilherme Benfatti Olivato, Jorge L. R. Paranhos, Iany G. da Silva, Adilson de C. Meireles, Viviane Cordeiro Veiga, Juliana Chaves Coelho, Maiko Moura Silveira, Agnes C. Lisboa, Marco A.V. Guedes, Luíz Carlos Santana Passos, Daniela C. Dorta, Ramana A. Rangel, Péricles Almeida Delfino Duarte, Eraldo de Azevedo Lúcio, Eduardo B. Tondo, Pablo A.A. Vaz, Paula K. de Oliveira, Lúcio Couto de Oliveira, Paulo H.P. Ferreira, Patrick Harrison Santana Sampaio, Maurício G.S. Serra, Thiago Lisboa, Caroline Fachini, André P. Torelly, Alldren Souza, Fábio Holanda Lacerda, Eliana V. N. Martins, Bruno Adler Maccagnan Pinheiro Besen, Carlos Eduardo Brandão, João Manoel Silva, Flávio W.F. Melo, Flávio A. dos Santos, Israel Silva Maia, Cássio Luis Zandonai, Eduardo Berbigier, Cíntia Magalhães Carvalho Grion, Josiane Festti, Ana Luiza Mezzaroba, José Andrade, Marianne Camargo, Adriano F. Teixeira, José de S. Andrade, Michele Maria Gonçalves de Godoy, Andréia de F. T. de Mendonça, Mara L.F.S. Mendes, Renata C.I.C. Beltrão, Edson Romano, Marcelo Luz Pereira Romano, André Falcão Pedrosa Costa, Jorge Farran, Felipe Dal‐Pizzol, Danusa Damásio, Renata Casagrande Gonçalves, Emerson Boschi, Luiz de F. Ferreira, Rafael Lessa da Costa, Kellen Lopes, Miquéias M.L. Silva, Douglas L.A.B. de Matos, Renata de A. Marques, Glauco Adrieno Westphal, Miriam Machado, Juliano Ramos, Luíz Marcelo Sá Malbouisson, Bruno N. Lucena, Marlus M. Thompson, Lanese Medeiros de Figueiredo, Luana Feitosa Mourão, Thiago Santos Garcês, Israel da S. Maia, Jaqueline F. Rohr, Fernanda Fontanela, Cassia P. B. Martins, Álvaro Réa-Neto, Fernanda Baeumle Reese, Mirella Cristine de Oliveira, André Luiz Nunes Gobatto, Luciana S. de Mattos, Carolaine B. de Oliveira, Meton S. de Alencar, Jussara A. Arraes, João G.T. Alves, Thiago C. De Morais, Antônio A. P. Fagundes, Roberta T. Tallarico, Thais Coutinho, Ronald Torres, Fernando José Ramos, Fernanda C. Athalla, Mauricio H.C. dos Santos, Paulo Maurício Garcia Nosé, Cássia Righy Shinotsuka, Pedro Kurtz, Bruno Guimarães, Luciana Guilhermino Pereira, Raquel B. Jupato, Bruno de Arruda Bravim, Marcos Freitas Knibel, Allan S. da Silva, Vinícius G. de Luca, Niklas Soderberg, Roseny dos Reis Rodrigues, Luis E.P. Pfingsten, Cassiano Teixeira, José H.D. Barth, Giselle C. Pratini, Luiz Dalfior, Márcio H. Kai, S Blecher, Hugo C. A. Urbano, Lucas L. Carvalho, Danielle C. A. Moreira, Ana L. S. Bernardes, Vandack Nobre, Paula Frizera Vassallo, Cecilia Gómez Ravetti, Ho Y. Li, Vivian Vieira Tenório Sales, Renata Guazzelli, Rafael David de Oliveira, Leandro Pozzo, Leandro Utino Taniguchi, Pedro Vitale Mendes, Suzana M Lobo, Miriam Machado, Ana B. B. Camacho, Pablo Oscar Tomba, Fred C. T. Lizidatti, Walter C. G. Baptista, Aline R. Moreira, Manoela M. de Sousa, Marcelo de Oliveira Santos, Karla Moretto, Priscilla A. de Martins, Liz M. L. de Souza, Thiago R. Sequeira, Manoel M. S. Pedrinha, Marcone L. S. da Rocha, Francisco R. V. Saleiro, Tatiana M. Clementino, Hélio Penna Guimarães, Marcos Cesar Ramos Mello, Mirella Cristine de Oliveira, Fernanda Baeumle Reese, Denise Milioli Ferreira, Fernanda Alves Ferreira Gonçalves, Roberta Muriel Longo Roepke, Bruno Martins Tomazini, Sidiner Mesquita Vaz, Miria Bonjour Laviola, Thiago Domingos Corrêa, Roger Monteiro Alencar, Denise N. Freitas, Heitor P. Póvoas, Liliane B. S. Passos, Juliane de M. Silva,

Respiratory Support and Mechanisms

Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU).Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design.The primary end point was 90-day survival.Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.ClinicalTrials.gov Identifier: NCT02875873.