Critical Illness, Shock
Conditions
Keywords
chloride, acidosis
Brief summary
The purpose of this study is to determine whether intravenous fluid management using lower chloride solutions (Hartmann's solutions and Plasmalyte®) will result in better outcome when compared to management using high chloride solutions (0.9% saline and Gelofusine®).
Detailed description
This is a prospective, controlled, before-and-after study. The baseline pre-intervention period will include collection of data while doctors and nurses are unaware that such collection is taking place. During this time, high chloride fluids (saline, Gelofusine, 4% albumin) will continue to be used according to standard practice with an estimated 30,000 liters of saline as well as 2,000 bottles of Gelofusine® being consumed. Following a wash out period of education and preparation, there will be a complete shift to a working environment where use of saline, Gelofusine and any other fluids with a high chloride level (\>110 mmol/L)will be restricted and substituted with fluids of lower chloride concentration similar to blood; either Hartmann's solution or Plasmalyte® or 20% albumin. The study will compare a 6 month control period (before) and a six month intervention period (after).
Interventions
DRUGLower chloride fluids (Hartmann's solution and Plasmalyte®)
Intravenous fluids used during the 6 month intervention period (after). Amount of fluids to be used is based on clinicians' discretion.
Sponsors
Austin Health
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* All Intensive Care Unit (ICU) admissions at Austin Hospital * All Emergency Department (ED) admissions at Austin Hospital * All operations at Operating Theatre (OT) with hospital stay of more than 48 hours
Exclusion criteria
Nil
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Mean base excess during hospital stay | Six month control period (before) and 6 month intervention period (after) |
Secondary
| Measure | Time frame |
|---|---|
| Serum creatine levels | Six month control period (before) and 6 month intervention period (after) |
| Length of ICU stay | Six month control period (before) and 6 month intervention period (after) |
| Unmeasured anions (strong ion gap) and chloride levels during hospital stay | Six month control period (before) and 6 month intervention period (after) |
| Length of hospital stay | Six month control period (before) and 6 month intervention period (after) |
| In-hospital mortality | Six month control period (before) and 6 month intervention period (after) |
| Length of Emergency Department stay | Six month control period (before) and 6 month intervention period (after) |
Countries
Australia
Outcome results
None listed