According to NCBI guideline, it is recommended to administer maintenance IV fluids required by the patient (30-40ml/kg/day) during day time to ensure good sleep for the patient and nurse. But this guideline didn't mention maximum accepted infusion rate for maintenance IV fluid !!! so how much maximum accepted rate and what are the possible complication if it is exceeded?
stick to the guidelines . too much fluid may cause pulmonary edemac
Ehab,
Patient-centered care demands assessment of the patient's needs. Many questions must be answered: 1)fluid loss, 2)renal status, 3)sepsis?, 4)cardiac status (ejection fraction), 5)oral intake, to name a few. Guidelines are just that, Guidelines. It incumbent upon those rendering care to adjust care base upon the patient specific variables. Fluid overload can lead to (as Khaled mentioned) pulmonary edema, atrial fibrillation (and its complications), electrolyte imbalance, altered mental status, cerebral edema, stroke, impaired wound healing, skin breakdown (and its complications). Hypovolemia can lead to renal failure, deep vein thrombosis, altered metal status, poor myocardial perfusion. Therefore, fluid imbalance leads to increased morbidity and mortality.
Regards,
Christopher
https://doi.org/10.1159/000313722
Critical Care201519:371
DOI: 10.1186/s13054-015-1085-4
Hi Ehab,
So agree with the above answers, use Guidelines but tailor you management according to the patient's individual needs.
Agree with the above and believe that in the ICU we shouldn't just do maintenance fluids. We should re-access the patients' needs on a regular basis. The timing and amount of fluid administered has been associated with mortality (https://www.ncbi.nlm.nih.gov/pubmed/24853382).
Hi All,
The body of hte question does not specify ICU. Maintainance can be gauged by the 4/2/1/ memo (4 ml/gk/hour for the first 10 kg, 2 for the next 20 kn and the rest 1). But, again, it's only an orientative formula. The key is to combine maths with clinics. BTW, think of the pletysmographyc aspect at te SpO2 monitor. It will usually help. a variation of more than 14% between Max and min pulse pressure values (PMax-Pmin/PMax) usually indicates fluid responsiveness in the ventilated patient. Well, in the non ventilated one the clinic should guide. A non ventlated patient is not in such a bad condition, isn't it!
Paul, I also believe it is important to point out that pulse pressure variation only works in patients who are in synchrony with the vent and are in sinus rhythm.
I would like to add, there is daily need in fluid (for example in enteral nutrition you have a lot of hidden water, all inputs and outputs should be calculated together with needs and daily aims, maximal rate is not needed because you have daily calculations and targets, you are daily giving fluid with just small amount during night).There is goal directed fluid therapy (the maximal rate is crucial because you are fighting for hemodynamics, you can see a lot in the new sepsis guidelines), and there is maintenance fluid for iv flush were speed is as slow as it can be.
We can't fix a maximum rate for i.v. infusion. either for adult or children, it is a multifactorial and has to be adjusted according to the patient
Guidelines help. But clinicians must assess patients input output as and tailor fluids to suit each patient. CAP, TEE, PULSE CONTOUR ANALYSIS ETC just help
The question is not so clear. It depends on the patient's condition. You have to individualize. More important is the fluid balance.
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