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Zampieri, Fernando G; Machado, Flávia R; Biondi, Rodrigo S; Freitas, Flávio G. R; Veiga, Viviane C; Figueiredo, Rodrigo C; Lovato, Wilson J; Amêndola, Cristina P; Assunção, Murillo S. C; Serpa-Neto, Ary; Paranhos, Jorge L. R; Andrade, José; 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; Corrêa, Thiago D; Azevedo, Luciano C. P; Kellum, John A; Damiani, Lucas P; Silva, Nilton B; Cavalcanti, Alexandre B
JAMA : the journal of the American Medical Association, 09/2021, Volume: 326, Issue: 9Journal Article
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 point was 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 1162 mL 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02875873
