Impact of IV infusion rate of critically ill patients
Abstract:
Purpose: We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.
Materials and methods: Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.
Results: We included 146 patients (slow rate: 71, fast rate: 75). One hour after the end of the infusion, there was no difference in the overall mean marginal effect on MAP between the groups [1.9 mmHg (95 % CI: -1.5 to 5.3 mmHg), p = 0.27] or on the perfusion parameters. Similarly, no difference was found in the immediate effect after 90 min [overall marginal effect: 1.1 mmHg (95 % CI: -2.3 to 4.6 mmHg); p = 0.52]. In patients with cardiac output (CO) monitoring, there was an increase in CO in the fast rate group (overall mean marginal effect: 1.78 L/min (95 % CI: 0.08 to 3.48 L/min); p = 0.04).
Conclusion: In critically ill patients, crystalloid infusion at both fast and slow rates did not lead to immediate or sustained differences in MAP. However, fast infusion may result in a greater increase in CO.
Reference:
Tomotani DYV, Freitas FGR, Cavalcante AB, Neto AS, Figueiredo RC, Biondi RS, Silva-Jr JM, Besen BAMP, da Rocha Paranhos JL, da Silva Ramos FJ, Atallah FC, de Almeida TML, de Souza MA, Zampieri FG, Machado FR; BRICNet. Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study. J Crit Care. 2024 Dec 18;86:154985. doi: 10.1016/j.jcrc.2024.154985. Epub ahead of print. PMID: 39700555.