Interventions and Practices Considered Assessment of patient for hypovolemia. Clinical examination (assessment of patient’s fluid status, pulse, blood pressure, capillary refill and jugular venous pressure presence of pulmonary or peripheral edema, presence of postural hypotension) Clinical monitoring (National Early Warning Score [NEWS], fluid balance charts, weight). Laboratory investigations (full blood count, urea, creatinine and electrolytes) Establishment of intravenous (IV) fluid management plan Reassessment using the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) Monitoring of respiratory rate, pulse, blood pressure and perfusion continuously, and measurement of venous lactate levels and/or arterial pH. Daily reassessments of clinical fluid status (laboratory values including urea, creatinine and electrolytes, fluid balance charts, along with weight measurement twice weekly). Reassessment of fluid status and IV fluid management plan on arrival in the new setting in patients who are transferred IV fluid resuscitation Routine maintenance: adjustment of fluids for specific patient populations. Obese patients Old and frail Impairment or cardiac failure Malnourished patients at risk of refeeding syndrome Delivery of IV fluids for routine maintenance during daytime hours to promote sleep and wellbeing Replacement and redistribution. Prescription adjustment Consultation of expert help if patients have a complex fluid and/or electrolyte redistribution issue or imbalance, or significant comorbidity Healthcare professional education and training Major Outcomes Considered All-cause mortality within 30 days of hospitalization Length of stay in hospital Length of stay in Intensive care unit Quality of life Renal complications/acute kidney injury (AKI) defined as an increase of 50% or more of serum creatinine from baseline. Respiratory complications including pulmonary oedema, respiratory failure, chest infection, mechanical ventilation Morbidity – measured by Sequential Organ Failure Assessment (SOFA) and Multiple Organ Dysfunction Score (MODS) Total volume of fluid received Hyperchloremia Hyperchloremic acidosis Hypochloremia Methodology Methods Used to Collect/Select the Evidence Hand-searches of Published Literature (Primary Sources) Hand-searches of Published Literature (Secondary Sources) Searches of Electronic Databases Description of Methods Used to Collect/Select the Evidence Note from the National Guideline Clearinghouse (NGC): This guideline was developed by the National Clinical Guideline Centre (NCGC) on behalf of the National Institute for Health and Care Excellence (NICE). See the “Availability of Companion Documents” field for the full version of this guidance.
