Fluid Therapy in the Intensive Care Unit

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Frazee, E., & Kashani, K. (2016). Fluid management for critically ill patients: A review of the current state of fluid therapy in the intensive care unit. Kidney Diseases, 2(2), 64-71.

Summary and Scope

Frazee and Kashani delve into reviewing the current state of fluid therapy. In particular, they have focused on the use of intravenous fluids which are essential for restoring intravenous volume among patients with the condition of hypovolemic shock. Within the article, there is the vast review of the benefits of the intravenous fluids as observed in critically ill patients in the intensive care units. Most importantly, the authors inform their target audience of the need to be informed of the potential risks resulting from volume overload and related effects on organ failure as well as mortality. In so doing, the authors recommend that medical practitioners should not only rely on the developed strategies identifying fluid responsiveness for the critical patients but also the efficacy of either the colloid or crystalloid solution. As medical experts at Mayo Foundation for Medical Education and Research, they have expertise in Anaesthetics, Emergency Medical Care, and Emergency Medicine. In addition to this article, they have written other forty-six articles that have been peer-reviewed and published. They are, thus, reliable authors who can be accessed for any comment regarding their work. Consequently, the authors through the article target medical practitioners who often handle critical patients in the intensive care unit. The authors’ work, nonetheless, illuminates my topic “Choice of Fluids for Resuscitation of the Critically Ill” by providing important information regarding the current state of fluids used for resuscitation.

Gross, W., Samarin, M., & Kimmons, L. A. (2017). Choice of Fluids for Resuscitation of the Critically Ill: What Nurses Need to Know. Critical care nursing quarterly, 40(4), 309-322.

Summary and Scope

Gross, Samarin, and Kimmons concerned with what nurses need to know in respect to the choice of fluids for resuscitation, discuss through a review the properties, adverse effects as well as the monitoring of the colloids and crystalloid solutions which make up the two main categories of resuscitation fluids. The three authors noted that, even though the fluid administration is internationally used as an intervention approach in the intensive care units, there is the limitation in regards to the particular resuscitation fluid to use. As such, they recommend based on the increasing evidence of choice and dose of the fluid type being influential in patient’s medical outcome that nurses develop an understanding between colloid and crystalloids and their potential side effects so as to make better decisions on fluids to use when caring for patients in the intensive care unit. As medical experts affiliated to a credible medical institution- the Methodist University Hospital, Memphis Tennesse, the authors have authority since they can be traced to any form of clarification or comment if the need arises. The authors’ information in the article specifically targets nurses managing patients in the intensive care units. Finally, the article illuminates my topic by highlighting specific properties and adverse effects of resuscitation fluids which are necessary for in-depth coverage of the topic.

Thoughts about the Selected Articles

Internationally, medical providers apply varying clinical protocols that impact the selection of the medically recommended resuscitation fluids. In such instances, the choice of a particular resuscitation fluid for the critically ill patients is dictated by regional as well as the physician preferences. The regional and the clinician preferences may be informed by the health facility’s protocols, the availability of a particular resuscitation fluid, and cost. Nevertheless, randomized systematic reviews in addition to examination of controlled trials reveal that little evidence exists to prove that using one particular resuscitation fluid is more effective compared to another. Two articles have been imperative in understanding that there are certain medical principles and factors that inform the choice of fluids for resuscitation of the critically ill. As learned from the readings, an ideal resuscitation fluid should exhibit certain properties including the ability to produce predictable as well as sustained intravascular volume expansion, be of a chemical composition as extracellular fluid, easily metabolized without systemic or adverse effects and fully excreted, and less expensive in regards to enabling the desired patient’s medical outcome. Unfortunately, comparative analyses of the two broad categories of resuscitation fluids “colloid and crystalloid solutions” show that there are no such ideal resuscitation fluids at the moment. Inferences from physiological principles and interpretations notwithstanding, colloid solutions typically have no measurable advantages over the crystalloid solutions as much as the correction of the hemodynamic condition is concerned. A clinician’s understanding of the manner in which fluid is distributed in the patient’s body plays an integral role in deciding the resuscitation fluid to use. For instance, he or she would use the knowledge of body fluids to compare the different fluid types while at the same time noting their effects with respect to intravascular volume expansion. In particular, water constitutes 60% of the total human body weight. That is divided into two compartments such that two-thirds and one-third are for the intracellular and extracellular respectively. The one-third extracellular fluid is further distributed to make up 25% and 75% intravascular space and interstitial space correspondingly. It is, thus, the intravascular space with normal electrolyte composition that is of target whenever resuscitation is done using the chosen fluid.

October 13, 2023

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