A review of adult resuscitative fluid purchasing and usage trends at an academic tertiary hospital in Johannesburg

Background
Intravenous fluid administration is a vital component in the resuscitation of critically ill patients. In recent years, there have been many studies to help guide which fluids should be used for resuscitation. Currently, it appears that the international trend is away from the use of colloids and unbalanced crystalloids and towards the use of balanced crystalloids. The aim of our study was to determine whether evolving international evidence has impacted resuscitative fluid practices in the Emergency Department (ED) and the Intensive Care Unit (ICU) in a tertiary hospital in South Africa.

Methods
The study design was two-fold: a cross-sectional physician survey and a retrospective longitudinal observational study of the pharmacy fluid purchase records from the combined ED and ICU.

Results
Cross-sectional survey: in 2020 a doctor was 8.3 times more likely to choose a balanced crystalloid for resuscitation regardless of the clinical scenario over any other fluid (CI: 5.0–13.8). 55% of doctors surveyed agreed that their resuscitation fluid of choice had changed for a variety of reasons with the most popular reason cited as post-graduate education. Retrospective longitudinal observational study: throughout the study period, balanced crystalloids were the majority fluid purchased, although in ED lactated Ringers was the preferred balanced crystalloid and in ICU PlasmaLyte was preferred. Minimal colloids were purchased over the study period in declining amounts.

Conclusions
Doctors working in a tertiary hospital in South Africa are following the trend of current evidence by using a balanced crystalloid as their resuscitation fluid of choice.