IV Fluid: Too Much of a Good Thing Can Kill You

By Chris Hutchison

I speak to physicians on a daily basis. I enjoy hearing their thoughts on improving patient care and safety, as I believe industry can play a key role in equipping doctors with information to improve decision making for their patients. While the conversations often start at 60,000-foot level about treatment protocols and medicines, we quickly engage around IV fluid management and the challenge of meeting the unique needs of each patient. Increasingly, studies have shown that what is best for the patient is not a “one size fits all” approach to IV fluids. In fact, just the opposite is true: improper fluid management can lead to serious complications, even death.

We all know that IV fluids offer significant benefits. They are essential whenever critically ill patients are admitted to the hospital, easing the administration of medicines, keeping patients hydrated and improving perfusion. That said, the more we learn about IV fluid and its effect on the kidneys, lungs and other vital organs, the more we understand the need to dose IV fluids the same way we do medicines: give only when they are needed and check to make sure they work.

Consider these findings:

• Research led by Dr. Thomas Hopkins of Duke University showed that intraoperative fluid administration influenced patient outcomes during and after surgery, including increased mortality, pulmonary and cardiac complications associated with higher fluid volumes.¹

• Research led by Paul Marik highlighted fluid overload as an independent risk factor for mortality, with a significant increase in mortality and hospital cost seen for each liter of fluid administered after 5L in patients with septic shock.²

• The recent FEDORA multi center, randomized controlled trial showed significant improvement in outcomes for patients randomized to receive goal directed fluid therapy compared to a usual care control group.³

These are just three examples of a growing body of evidence indicating IV fluid administration deserves attention. These facts are a call-to-action for physicians and hospitals alike.

For physicians, doing no harm with IV fluids requires them to assess fluid dose for each patient.  Many physicians still opt for older, less effective standards that they have been using since their days in medical school. Some severely restrict fluid to patients with a history of congestive heart failure (CHF), or “tank up” patients with perfusion insufficiency, counting on someone else to “take off the excess volume” later. Others have embraced technology to help reinvent what they do every day – and look for next generation solutions that enable them to work smartly and safely with patients under their care. IV fluid management is on their list. 

While the number of physicians implementing these tests is growing, it is time to accelerate the adoption rate. 

Proper fluid management can provide significant operational benefit to hospitals. It can save lives, as demonstrated above, and it allows patients to move out of the ICU faster, making room for other critically ill patients. Appropriately managed patients can also require fewer risky and costly interventions like dialysis and mechanical ventilation. One recent study by the University of Kansas Medical Center found over $14,000 could be saved per treated patient by reducing the number of these costly interventions. That’s good news, but to get there, hospital administrators must review IV guidelines and protocols and ensure they reflect the newest research – and their physicians follow them. 

The days of following outdated IV fluid management practices are long gone. With new evidence in hand, personalized fluid monitoring and treatment are literally a matter of life and death. The life saved as a result could be your own.

Chris Hutchison is president and CEO of Cheetah Medical, global provider of 100 percent non-invasive fluid management monitoring technologies, designed for use in critical care, operating room and emergency department settings.