Intravenous Fluids

Key points

  • Fluid choice continues to be mainly determined by clinician and regional preferences
  • The choice of IV fluid affects patient outcome, with urgent need for further research into optimal fluid therapy
  • CIT TAIT (‘sit tight’): Context, Indication, Targets, Timing, Amount of fluid, Infusion strategy, Type of fluid

In this section, we review the evidence and current recommendations for the use of IV fluids. 

Intravenous fluids used for the resuscitation of acutely ill patients comprise of colloid and crystalloid solutions (Myburgh & Mythen, 2013; McDermid et al., 2014; Myburgh, 2015). Although physiological principles underpin the use of resuscitation fluids for the treatment of acutely ill patients, the choice of resuscitation fluids in clinical practice is determined mainly by clinician preference (Myburgh & Mythen, 2013).  Country preferences are also a factor in the choice of fluid (Hammond et al., 2017).

Emerging evidence from multiple randomised controlled trials (RCTs) indicates that the choice of resuscitation fluid affects outcomes of patients, and that patient-specific and context-specific characteristics should be considered for selection of a resuscitation fluid (Myburgh & Mythen, 2013; McDermid et al., 2014; Myburgh, 2015). However, there is still an urgent need for more high-quality RCTs to resolve a number of contentious issues that exist in fluid therapy in acute medicine (Myburgh, 2015).

Personalised fluid resuscitation requires careful attention to the factors listed in the acronym CIT TAIT (or ‘sit tight’). These are: context, indication, targets, timing, amount of fluid, infusion strategy, and type of fluid (van Haren, 2017).

National Institute for Health and Care Excellence (NICE) guidelines for intravenous fluid therapy in hospitalised adults and children have been published (NICE, 2013, 2017).