PETER T-L CHOI
In 1918, Captain WB Cannon described the use of intravenous (IV) fluid for the prevention of wound shock on the battlefield.1,2 Since then, IV fluid administration has become an integral part of volume resuscitation and replacement in surgical and critically ill patients. However, the choice of IV fluid, the timing of fluid administration, and the volume of fluid remain vigorously debated topics.
Initial rationale for the use of particular IV fluids was based mainly on pharmacological mechanisms and physiological outcomes. Although important, these end points were insufficient to define clinical practice. The effect of IV fluids on clinical outcomes, such as mortality, would be a more compelling reason on which to base one's choice of IV fluid. Unfortunately, attempts to draw conclusions on clinical outcomes based on randomised controlled trials were hampered by small sample sizes and insufficient power, heterogeneous populations, and differences in fluid regimens between studies, despite more than 50 randomised controlled trials being published over the past 40 years. Thus, conclusions on the effect of different IV fluids on morbidity and mortality, which are more likely to influence clinicians, have not been forthcoming from individual randomised controlled trials.
In an attempt to answer some questions relating to fluid therapy, systematic review and meta-analysis have been used to pool the results from randomised controlled trials. The resultant evidence has provided some answers, changed clinical practice, identified areas requiring further research, and, at times, generated controversy. In this chapter, the evidence from systematic reviews on the choice of IV fluids will be reviewed.
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