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  3. Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients The BaSICS Randomized Clinical Trial

Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients The BaSICS Randomized Clinical Trial

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • José Paulo Alves Vieira De Andrade

    Autor

Participantes de fora da FMUP

  • Zampieri, Fernando G.
  • Machado, Flavia R.
  • Biondi, Rodrigo S.
  • Freitas, Flavio G. R.
  • Veiga, Viviane C.
  • Figueiredo, Rodrigo C.
  • Lovato, Wilson J.
  • Amendola, Cristina P.
  • Assuncao, Murillo S. C.
  • Serpa-Neto, Ary
  • Paranhos, Jorge L. R.
  • Godoy, Michele M. G.
  • Romano, Edson
  • Dal Pizzol, Felipe
  • Silva, Emerson B.
  • Silva, Miqueias M. L.
  • Machado, Miriam C. V.
  • Malbouisson, Luiz Marcelo S.
  • Manoel, Airton L. O.
  • Thompson, Marlus M.
  • Figueiredo, Lanese M.
  • Soares, Rafael M.
  • Miranda, Tamiris A.
  • de Lima, Lucas M.
  • Santucci, Eliana V.
  • Correa, Thiago D.
  • Azevedo, Luciano C. P.
  • Kellum, John A.
  • Damiani, Lucas P.
  • Silva, Nilton B.
  • Cavalcanti, Alexandre B.
  • BaSICS Investigators BRICNet Memb

Unidades de investigação

Abstract

IMPORTANCE Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality. OBJECTIVE To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately). INTERVENTIONS Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design. MAIN OUTCOMES AND MEASURES The primary end pointwas 90-day survival. RESULTS Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98). CONCLUSIONS AND RELEVANCE Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

Dados da publicação

ISSN/ISSNe:
1538-3598, 0098-7484

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION  American Medical Association

Tipo:
Article
Páginas:
830-838
PubMed:
34547081

Citações Recebidas na Web of Science: 41

Citações Recebidas na Scopus: 52

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Keywords

  • INTENSIVE-CARE; INFUSION; SALINE; RESUSCITATION

Campos de Estudo

Projetos associados

Neurosurgical anatomy of the insular cortex

Investigador Principal: José Paulo Alves Vieira de Andrade

Estudo Clínico Académico . 2020

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