Title: "BaSICS (Balanced Solutions in Intensive Care Study) Trial: Slower vs. Faster IVF Boluses" submitted on behalf of Dr. Caleb Chan<br/>Author: Kami Windsor<br/><a href='http://umem.org/profiles/faculty/742/'>[Click to email author]</a><hr/><p class="x_MsoNormal" style="margin: 0in 0in 0.0001pt; font-size: 12pt; font-family: Calibri, sans-serif; color: rgb(32, 31, 30);">
<strong style="font-size: 12px;"><span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: Helvetica; vertical-align: baseline; color: inherit;">Background:</span></strong></p>
<p class="x_MsoNormal" style="margin: 0in 0in 0.0001pt; font-size: 12pt; font-family: Calibri, sans-serif; color: rgb(32, 31, 30);">
<span style="font-size:12px;"><span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: Helvetica; vertical-align: baseline; color: inherit;">There are also no clear guidelines regarding how fast fluid boluses should be administered, and there has been debate about whether different infusion rates could lead to different outcomes in patients receiving intravenous fluid (IVF) boluses (i.e. fast infusions may cause more third spacing due to the rapidity of the expansion of the intravascular space compared to fluid administered more slowly). A recent study compared IVF infusion rates in ICU patients.</span></span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">-- Unblinded, randomized</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">-- 10,520 patients clinically requiring a fluid challenge, from 75 ICUs in Brazil</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">-- Infusion rate 333 mL/hr vs 999 mL/hr</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;"> * (Trial also compared plasmalyte vs 0.9% saline, analyzed in separate study)</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">-- Some notable exclusion criteria: severe hypo/hypernatremia, AKI or expected to need RRT 6 hrs after admission</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">--Other caveats:</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;"> * Faster infusion rates allowed at physician discretion in patients with active bleeding or severe hypotension (SBP < 80 or MAP < 50 mmHg); patient was returned to assigned rate after condition resolved</span></p>
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<span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;"> * Almost 1/2 the patients received at least 1L of IVF in 24 hours prior to enrollment</span></p>
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-- <u style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">Results</u><span style="font-size: 12px; color: rgb(34, 34, 34); font-family: Arial, Verdana, sans-serif;">: No sig difference in 90-day survival, use of RRT, AKI, mechanical ventilator free days, ICU/hospital mortality/LOS </span></p>
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<span style="font-size:12px;"><strong style="color: inherit; font-family: Helvetica; font-size: 9pt; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit;">Bottom Line:</strong><span style="color: inherit; font-family: Helvetica; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit;"> There is not yet compelling evidence that there are differences in patient outcomes in patients receiving fluid boluses given at 333 cc/hr vs. 999 cc/hr.</span></span></p>
<fieldset><legend>References</legend>
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<span style="font-size: 10pt; font-family: Helvetica; color: rgb(32, 31, 30);">1. Zampieri FG, Machado FR, Biondi RS, et al. Effect of slower vs faster intravenous fluid bolus rates on mortality in critically ill patients: the basics randomized clinical trial. JAMA. Published online August 10, 2021.</span><span color:="" helvetica="" style="font-size: 10pt; font-family: ">doi:10.1001/jama.2021.11444</span><span style="font-size: 10pt; font-family: Arial, sans-serif; color: rgb(34, 34, 34);"><o:p></o:p></span></p>
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<span style="font-size: 10pt; font-family: Helvetica; color: rgb(32, 31, 30);">2. Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0. 9% saline solution on mortality in critically ill patients: the basics randomized clinical trial. JAMA. Published online August 10, 2021.</span><span style="font-size: 10pt; font-family: Arial, sans-serif; color: rgb(34, 34, 34);"><o:p></o:p></span></p>
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