Role of Fluid Stewardship in the Critically Ill

A mixture of sodium, bicarbonate, chloride, and water was first infused into a human vein in 1832 and has since been a universal component of critical care medicine.¹  Intravenous fluids are the most commonly administered medications in critically ill adults.²  Like all medications, intravenous fluids should be administered for an appropriate indication and duration with consideration for adverse effects. Intravenous fluids are used inappropriately in approximately 20% of patients, increasing the risk of fluid overload.²  Detrimental consequences of fluid overload include organ dysfunction, longer hospital stay, and increased risk of mortality. This article reviews the evidence related to intravenous fluid administration and defines the core concepts of fluid stewardship in the critical care setting.

Crystalloid fluids are solutions of electrolytes in water that cross freely from the vascular space into the extravascular space through semipermeable membranes, such as capillary walls.²  More than 200 million liters of...