Dataset Information

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS.

ABSTRACT:

Objective

To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.

Methods

This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.

Results

On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.

Conclusion

Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

SUBMITTER: Freitas FGR

PROVIDER: S-EPMC8275089 | biostudies-literature | 2021 Apr-Jun

REPOSITORIES: biostudies-literature

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Publications

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS.

Freitas Flavio Geraldo Rezende de FGR Hammond Naomi N Li Yang Y Azevedo Luciano Cesar Pontes de LCP Cavalcanti Alexandre Biasi AB Taniguchi Leandro L Gobatto André A Japiassú André Miguel AM Bafi Antonio Tonete AT Mazza Bruno Franco BF Noritomi Danilo Teixeira DT Dal-Pizzol Felipe F Bozza Fernando F Salluh Jorge Ibrahin Figueira JIF Westphal Glauco Adrieno GA Soares Márcio M Assunção Murillo Santucci César de MSC Lisboa Thiago T Lobo Suzana Margarete Ajeje SMA Barbosa Achilles Rohlfs AR Ventura Adriana Fonseca AF Souza Ailson Faria de AF Silva Alexandre Francisco AF Toledo Alexandre A Reis Aline A Cembranel Allan A Rea Neto Alvaro A Gut Ana Lúcia AL Justo Ana Patricia Pierre APP Santos Ana Paula AP Albuquerque André Campos D de ACD Scazufka André A Rodrigues Antonio Babo AB Fernandino Bruno Bonaccorsi BB Silva Bruno Goncalves BG Vidal Bruno Sarno BS Pinheiro Bruno Valle BV Pinto Bruno Vilela Costa BVC Feijo Carlos Augusto Ramos CAR Abreu Filho Carlos de C Bosso Carlos Eduardo da Costa Nunes CEDCN Moreira Carlos Eduardo Nassif CEN Ramos Carlos Henrique Ferreira CHF Tavares Carmen C Arantes Cidamaiá C Grion Cintia C Mendes Ciro Leite CL Kmohan Claudio C Piras Claudio C Castro Cristine Pilati Pileggi CPP Lins Cyntia C Beraldo Daniel D Fontes Daniel D Boni Daniela D Castiglioni Débora D Paisani Denise de Moraes DM Pedroso Durval Ferreira Fonseca DFF Mattos Ederson Roberto ER Brito Sobrinho Edgar de E Troncoso Edgar M V EMV Rodrigues Filho Edison Moraes EM Nogueira Eduardo Enrico Ferrari EEF Ferreira Eduardo Leme EL Pacheco Eduardo Souza ES Jodar Euzebio E Ferreira Evandro L A ELA Araujo Fabiana Fernandes de FF Trevisol Fabiana Schuelter FS Amorim Fábio Ferreira FF Giannini Fabio Poianas FP Santos Fabrício Primitivo Matos FPM Buarque Fátima F Lima Felipe Gallego FG Costa Fernando Antonio Alvares da FAAD Sad Fernando Cesar Dos Anjos FCDA Aranha Fernando G FG Ganem Fernando F Callil Flavio F Costa Filho Francisco Flávio FF Dall Arto Frederico Toledo Campo FTC Moreno Geovani G Friedman Gilberto G Moralez Giulliana Martines GM Silva Guilherme Abdalla da GAD Costa Guilherme G Cavalcanti Guilherme Silva GS Cavalcanti Guilherme Silva GS Betônico Gustavo Navarro GN Betônico Gustavo Navarro GN Reis Hélder H Araujo Helia Beatriz N HBN Hortiz Júnior Helio Anjos HA Guimaraes Helio Penna HP Urbano Hugo H Maia Israel I Santiago Filho Ivan Lopes IL Farhat Júnior Jamil J Alvarez Janu Rangel JR Passos Joel Tavares JT Paranhos Jorge Eduardo da Rocha JEDR Marques José Aurelio JA Moreira Filho José Gonçalves JG Andrade Jose Neto JN Sobrinho José Onofre de C JOC Bezerra Jose Terceiro de Paiva JTP Alves Juliana Apolônio JA Ferreira Juliana J Gomes Jussara J Sato Karina Midori KM Gerent Karine K Teixeira Kathia Margarida Costa KMC Conde Katia Aparecida Pessoa KAP Martins Laércia Ferreira LF Figueirêdo Lanese L Rezegue Leila L Tcherniacovsk Leonardo L Ferraz Leone Oliveira LO Cavalcante Liane L Rabelo Ligia L Miilher Lilian L Garcia Lisiane L Tannous Luana L Hajjar Ludhmila Abrahão LA Paciência Luís Eduardo Miranda LEM Cruz Neto Luiz Monteiro da LMD Bley Macia Valeria MV Sousa Marcelo Ferreira MF Puga Marcelo Lourencini ML Romano Marcelo Luz Pereira MLP Nobrega Marciano M Arbex Marcio M Rodrigues Márcio Leite ML Guerreiro Márcio Osório MO Rocha Marcone M Alves Maria Angela Pangoni MAP Alves Maria Angela Pangoni MAP Rosa Maria Doroti MD Dias Mariza D'Agostino MD Martins Miquéias M Oliveira Mirella de M Moretti Miriane Melo Silveira MMS Matsui Mirna M Messender Octavio O Santarém Orlando Luís de Andrade OLA Silveira Patricio Júnior Henrique da PJHD Vassallo Paula Frizera PF Antoniazzi Paulo P Gottardo Paulo César PC Correia Paulo P Ferreira Paulo P Torres Paulo P Silva Pedro Gabrile M de Barros E PGMBE Foernges Rafael R Gomes Rafael R Moraes Rafael R Nonato Filho Raimundo R Borba Renato Luis RL Gomes Renato V RV Cordioli Ricardo R Lima Ricardo R López Ricardo Pérez RP Gargioni Ricardo Rath de Oliveira RRO Rosenblat Richard R Souza Roberta Machado de RM Almeida Roberto R Narciso Roberto Camargo RC Marco Roberto R Waltrick Roberto R Biondi Rodrigo R Figueiredo Rodrigo R Dutra Rodrigo Santana RS Batista Roseane R Felipe Rouge R Franco Rubens Sergio da Silva RSDS Houly Sandra S Faria Sara Socorro SS Pinto Sergio Felix SF Luzzi Sergio S Sant'ana Sergio S Fernandes Sergio Sonego SS Yamada Sérgio S Zajac Sérgio S Vaz Sidiner Mesquita SM Bezerra Silvia Aparecida Bezerra SAB Farhat Tatiana Bueno Tardivo TBT Santos Thiago Martins TM Smith Tiago T Silva Ulysses V A UVA Damasceno Valnei Bento VB Nobre Vandack V Dantas Vicente Cés de Souza VCS Irineu Vivian Menezes VM Bogado Viviane V Nedel Wagner W Campos Filho Walther W Dantas Weidson W Viana William W Oliveira Filho Wilson de W Delgadinho Wilson Martins WM Finfer Simon S Machado Flavia Ribeiro FR

Revista Brasileira de terapia intensiva 20210401 2

<h4>Objective</h4>To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.<h4>Methods</h4>This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countri ...[more]

PMID: 34231801

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Project description:IntroductionRecent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients.MethodsWe conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products).ResultsDuring the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score).ConclusionsAdministration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.

Project description:BACKGROUND:Point-of-care ultrasonography (POCUS) has recently become a useful tool that intensivists are incorporating into clinical practice. However, the incorporation of ultrasonography in critical care in developing countries is not straightforward. METHODS:Our objective was to investigate current practice and education regarding POCUS among Brazilian intensivists. A national survey was administered to Brazilian intensivists using an electronic questionnaire. Questions were selected by the Delphi method and assessed topics included organizational issues, POCUS technique and training patterns, machine availability, and main applications of POCUS in daily practice. RESULTS:Of 1533 intensivists who received the questionnaire, 322 responded from all of Brazil's regions. Two hundred and five (63.8%) reported having access to an ultrasound machine dedicated to the intensive care unit (ICU); however, this was more likely in university hospitals than in non-university hospitals (80.6 vs. 59.6%; risk ratio [RR]?=?1.35 [1.16-1.58], p?=?0.002). The main applications of POCUS were ultrasound-guided central vein catheterization (49.4%) and bedside echocardiographic assessment (33.9%). Two hundred and fifty-eight (80.0%) reported having at least one POCUS-trained intensivist in their staff (trained units). Trained units were more likely to perform routine ultrasound-guided jugular vein catheterization than non-trained units (38.6 vs. 16.4%; RR?=?2.35 [1.31-4.23], p?=?0.001). The proportion of POCUS-trained intensivists and availability of a dedicated ultrasound machine were both independently associated with performing ultrasound-guided jugular vein catheterization (RR?=?1.91 [1.32-2.77], p?=?0.001) and (RR?=?2.20 [1.26-3.29], p?=?0.005), respectively. CONCLUSIONS:A significant proportion of Brazilian ICUs had at least one intensivist with POCUS capability in their staff. Although ultrasound-guided central vein catheterization constitutes the main application of POCUS, adherence to guideline recommendations is still suboptimal.

Dataset Information

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS.

Objective

Methods

Results

Conclusion

Publications

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS.

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