Oct 16, 2026 · 23 min · 15 segments
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, Preeti Malani, MD, MSJ, Deputy Editor, and Christopher W. Seymour, MD, MSc, Associate Editor of JAMA,the Journal of the…
Kirsten Bibbins-DomingoHost
Preeti MalaniHostChristopher W. SeymourGuestWell, Kirsten, let's kick things off with a question that intensivists deal with every day.
Where are all the fluids really coming from in patients that are ventilated in the ICU? In the PROFLUID study, Dr.
Block and colleagues conducted a prospective international cohort study in two hundred and six ICUs in forty-one countries on six continents, and analyzed two thousand four hundred and fifty-four adults who were mechanically ventilated early in their ICU stay.
The primary outcomes were the type and amount of fluid administered to patients.
The authors report that the daily fluid input peaked at three liters on day one of intubation, and fluid balance was close to neutral by day three.
What really stood out to me was that resuscitation fluid made up only sixteen percent of the total volume.
And instead, maintenance and replacement fluids accounted for about thirty-two percent.
These are the so-called creep fluids, the fluid used to give medications and keep lines open.
Balanced crystalloids made up half of intravenous fluid, and saline about twenty-seven percent, while colloids were rare.
And after case mix adjustment, fluid therapy varied widely across the study sites.
From this important study, the main message is that among patients that are ventilated in the ICU, most fluid exposure now comes from maintenance and medication-related fluids, not classic resuscitation.
Um, all those little fluid boluses really do add up, and that's important information for intensive care clinicians and teams in the hospital.
I think the creep and maintenance fluid finding is really important and deserves a lot of future study.
Well, Kirsten, let's kick things off with a question that intensivists deal with every day.
Where are all the fluids really coming from in patients that are ventilated in the ICU? In the PROFLUID study, Dr.
Block and colleagues conducted a prospective international cohort study in two hundred and six ICUs in forty-one countries on six continents, and analyzed two thousand four hundred and fifty-four adults who were mechanically ventilated early in their ICU stay.
The primary outcomes were the type and amount of fluid administered to patients.
The authors report that the daily fluid input peaked at three liters on day one of intubation, and fluid balance was close to neutral by day three.
What really stood out to me was that resuscitation fluid made up only sixteen percent of the total volume.
And instead, maintenance and replacement fluids accounted for about thirty-two percent.
These are the so-called creep fluids, the fluid used to give medications and keep lines open.
Balanced crystalloids made up half of intravenous fluid, and saline about twenty-seven percent, while colloids were rare.
And after case mix adjustment, fluid therapy varied widely across the study sites.
From this important study, the main message is that among patients that are ventilated in the ICU, most fluid exposure now comes from maintenance and medication-related fluids, not classic resuscitation.
Um, all those little fluid boluses really do add up, and that's important information for intensive care clinicians and teams in the hospital.
I think the creep and maintenance fluid finding is really important and deserves a lot of future study.
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