A burning question in treating the most seriously ill patients with severe blood poisoning is how much fluid they should have. Research from Rigshospitalet and a number of other hospitals now shows that intensive-care departments can cut fluid treatment in half without any increase in the risk that patients will die or suffer serious adverse effects.
In a clinical trial, the researchers compared the current standard fluid treatment for blood poisoning (average 3.8 litres per patient) with more restrictive use of fluids (1.8 litres). After three months, both the mortality rates and the number of serious adverse effects were the same in the two groups.
“My personal view is that, on the basis of these results, we should be more restrictive in our use of fluid treatment for patients with severe blood poisoning. These patients have a lot of treatments, and we want to simplify their treatment, provided this doesn’t adversely affect the patients.
Four out of ten die
Blood poisoning is a frequent cause of death in intensive-care departments, and around 40% of patients die within three months. Anders Perner and his colleagues at intensive care departments in Denmark and abroad are therefore constantly trying to find improvements in the many routine treatments to save more patients.
“There’s been much concern among researchers that we sometimes give too much intravenous fluid treatment, because the excess fluid ends in the organs. We haven’t got a final answer to how much fluid they need, but our results will help validate a dose within the framework we’re investigating in the trial. This is good to know.
The study also indicates that if the sub-group of intensive-care patients who need a respirator are given less fluid, the risk of death could be even lower, but this will have to be confirmed in new trials.
Clinical guidelines should be changed in North America
According to Anders Perner, there may be reason for North Americans to pay extra attention to the results. Intensive-care departments in North America tend to use more fluid treatment than the standard in Denmark.
"Our experiments should encourage North Americans to think about changing their guidelines to reduce the use of fluid treatment. The doses of fluid we examined were safe, but we believe there is a maximum safe dose, and if we exceed this dose the fluid will be harmful for patients,” said Anders Perner.
The trial is being conducted at a number of intensive care departments in Denmark, Norway, Sweden, the UK, Switzerland, Italy and Belgium, and it is being funded by the Novo Nordisk Foundation and Rigshospitalet. The trials will continue with a one-year follow-up in which the researchers will examine whether the quality of life of the patients and their cognitive function are affected by the amount of fluid treatment they received while they were in intensive care.