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Abstract
The administration of fluid resuscitation to critically ill patients is a common intervention. High quality research evidence suggests that fluid type can impact on important patient outcomes. When new knowledge is generated the next step is translating this evidence into practice to ensure patients receive the best available treatments. The aim of this thesis was to use mixed methods to describe national and international trends of fluid resuscitation use in relation to key published research between 2007 and 2013 to determine if knowledge translation had occurred and secondly to describe key drivers for clinicians’ choice of fluid resuscitation. The main findings are:
1) In a series of point prevalence studies tracking fluid resuscitation practices in Australia and New Zealand over a 6-year period:
a. Fluid resuscitation practices changed between 2007 and 2013
b. The use of 0.9% sodium chloride remained unchanged, but the use of buffered salt solutions increased
c. There was a decreased use of semi-synthetic colloids, specifically gelatin
2) In a large international cross-sectional study of fluid resuscitation practices in 2014:
a. Crystalloids were used more often than colloids
b. The drivers for this were increasing use of buffered salt solutions and a decreasing use of the semi-synthetic colloids gelatin and hydroxyethyl starch
c. Geographical location was an independent determinant for the type of fluid administered
3) In an analysis of fluid resuscitation practices in the same intensive care units from two international cross-sectional studies:
a. Fluid resuscitation practices changed between 2007 and 2014
b. There was a significant increase in the administration of crystalloids in 2014 compared with 2007, specifically buffered salt solutions
4) In a discrete choice experiment survey determining drivers of fluid resuscitation choice of Australia and New Zealand intensive care clinicians’:
a. The three most important factors contributing to doctor’s decision making were; safety concerns, type of fluid, and patient diagnosis
From these findings, funding has been obtained to conduct a blinded, randomised controlled trial comparing a buffered salt solution to 0.9% sodium chloride for fluid resuscitation on all cause 90-day mortality in 8,800 critically ill adult patients.