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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1758476
Original Article

Variability in Clinician Awareness of Intravenous Fluid Administration in Critical Illness: A Prospective Cohort Study

Stephen M. Gorga 
1   Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States
,
Alexander L. Sliwicki
1   Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States
,
Julie Sturza
1   Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States
,
Erin F. Carlton
1   Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States
2   Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
,
Ryan P. Barbaro   *
1   Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States
2   Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
,
Rajit K. Basu   *
3   Ann & Robert Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, Chicago, Illinois, United States
› Author Affiliations Funding R.P.B. reports grants from the National Institutes of Health (R01 HL153519-ASCEND; K12 HL138039-TACTICAL; R01 HD01543-Pediatric Implantable Artificial Lung) outside the submitted work. E.F.C. reports grants from the National Institutes of Health (K12 HL138039-TACTICAL; KL2 TR 002241; UL1 TR 002240) outside the submitted work. R.K.B. reports consulting fees from BioPorto Diagnostics and BioMerieux.
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Abstract

Intravenous (IV) fluids are commonly administered to critically ill children, but clinicians lack effective guidance for the correct dose and duration of therapy resulting in variation of prescribing habits which harm children. It is unknown if clinicians recognize the amount of IV fluid that patients receive. We aimed to determine clinician's accuracy in the identification of the volume of IV fluids patients will receive over the next 24 hours. Prospective cohort study enrolled all patients admitted to the pediatric intensive care unit (PICU) from May to August 2021 at the University of Michigan's C.S. Mott Children's Hospital PICU. For each patient, clinicians estimated the volume of IV fluid that patients will receive in the next 24 hours. The primary outcome was accuracy of the estimation defined as predicted volume of IV fluids versus actual volume administered within 10 mL/kg or 500 mL depending on patient's weight. We tested for differences in accuracy by clinician type using chi-square tests. There were 259 patients for whom 2,295 surveys were completed by 177 clinicians. Clinicians' estimates were accurate 48.8% of the time with a median difference of 10 (1–26) mL/kg. We found that accuracy varied between clinician type: bedside nurses were most accurate at 64.3%, and attendings were least accurate at 30.5%. PICU clinicians have poor recognition of the amount of IV fluids their patients will receive in the subsequent 24-hour period. Estimate accuracy varied by clinician's role and improved over time, which may suggest opportunities for improvement.

Keywords

fluid overload - fluid administration - medication - assessment - survey

* Drs. Barbaro and Basu are recognized as senior authors in this manuscript.


Supplementary Material



Publication History

Received: 23 August 2022

Accepted: 23 September 2022

Article published online:
21 November 2022

© 2022. Thieme. All rights reserved.

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