ArticleIntensive care medicine2018
Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population.
Article in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07189091 (Effect of Reduced Sodium Chloride in Fluid Creep and Maintenance Fluids in Critically Ill Adults), which is not on this map. Cited by 109 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Reduced Sodium Chloride in Fluid Creep and Maintenance Fluids in Critically Ill Adults: A Randomized Controlled Trial
Who cites it
109 citing papers in PubMed, 2 syntheses or guidelines pooled it, 225 citations in OpenAlex.
- Acetate- versus lactate-buffered crystalloid solutions: A systematic review with meta-analysis and trial sequential analysis.Acta anaesthesiologica Scandinavica · 2022Pooled it
- Terms, Definitions, Nomenclature, and Routes of Fluid Administration.Frontiers in veterinary science · 2020Pooled it
- Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.The New England journal of medicine · 2026Trial
- REstrictive versus StandarD FlUid Management in Mechanically Ventilated ChildrEn Admitted to PICU: a pilot randomized controlled trial (REDUCE-1).Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2026Trial
- Impact of protocolized restrictive versus liberal/usual maintenance fluid strategy on fluid overload among mechanically ventilated children: an open-label randomized trial (ReLiSCh-II trial).European journal of pediatrics · 2026Trial
- Restrictive versus standard intravenous fluid therapy and NTproBNP in ICU patients with septic shock - a sub-study of the randomised CLASSIC trial.BMC anesthesiology · 2026Trial
- The Effects of Conservative Fluid Management and Active Deresuscitation on Markers of Tissue Perfusion, Kidney Injury, and Vascular Injury in Critically Ill Adults: A Secondary Analysis of the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) Trial.Critical care explorations · 2026Trial
- Effect of normal saline and half saline preservation serums on sodium levels, blood pressure, and acidosis in PICU patients.Medicine · 2026Trial
- Restrictive Versus Standard Intravenous Fluid Therapy and Endothelial Glycocalyx Shedding in ICU Patients With Septic Shock-A Preplanned Sub-Study of the Randomized CLASSIC Trial.Acta anaesthesiologica Scandinavica · 2026Trial
- Restrictive fluid management with early de-escalation versus usual care in critically ill patients (reduce trial): a feasibility randomized controlled trial.Critical care (London, England) · 2025Trial
- Impact on fluid balance of an optimized restrictive strategy targeting non-resuscitative fluids in intensive care patients with septic shock: a single-blind, multicenter, randomized, controlled, pilot study.Critical care (London, England) · 2024Trial
- Fluid balance neutralization secured by hemodynamic monitoring versus protocolized standard of care in patients with acute circulatory failure requiring continuous renal replacement therapy: results of the GO NEUTRAL randomized controlled trial.Intensive care medicine · 2024Trial
- Protocolized reduction of non-resuscitation fluids versus usual care in septic shock patients (REDUSE): a randomized multicentre feasibility trial.Critical care (London, England) · 2024Trial
- Optimizing Fluid Management Guided by Volumetric Parameters in Patients with Sepsis and ARDS.International journal of molecular sciences · 2023Trial
- Effect of Saline vs Gluconate/Acetate-Buffered Solution vs Lactate-Buffered Solution on Serum Chloride Among Children in the Pediatric Intensive Care Unit: The SPLYT-P Randomized Clinical Trial.JAMA pediatrics · 2023Trial
- Feasibility of conservative fluid administration and deresuscitation compared with usual care in critical illness: the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) randomised clinical trial.Intensive care medicine · 2022Trial
- Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.Intensive care medicine · 2021Trial
- Trial
- Oral water ingestion in the treatment of shock patients: a prospective randomized study.Intensive care medicine · 2020Trial
- 154 compared to 54 mmol per liter of sodium in intravenous maintenance fluid therapy for adult patients undergoing major thoracic surgery (TOPMAST): a single-center randomized controlled double-blind trial.Intensive care medicine · 2019Trial
49 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeResearch on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes.
methodsWe precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity.
resultsMaintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308-1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5-31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9-3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids.
conclusionsInadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.