(1397) Fluid Management and Deresuscitation Practices of Surgical Intensivists

Introduction: Excessive volume and positive fluid balance has been shown to result in worse outcomes in critically ill patients. Recently, emphasis has been placed on mindful fluid resuscitation followed by active fluid removal, a process referred to as deresuscitation. Patients in the Surgical ICU have unique fluid shifts relative to their surgery. There remains limited information regarding the use of deresuscitation in Surgical ICU populations. This study aims to characterize the fluid management and deresuscitation practices of surgical intensivists.

Methods: A convenience sample of surgical intensivists were emailed an anonymous link for the electronic survey. Information regarding demographics, clinical practice, and opinions regarding fluid management and deresuscitation were obtained. Surveys with partially missing data were included for analysis utilizing the appropriate adjustments.

Results: Response rate of the survey was 41% (16/34). Most respondents were double-board certified in General Surgery and Surgical Critical Care (12/14). Half worked at academic centers. All believed fluid balance is an important part of a patient's clinical state and most discussed fluid status on every patient every day. The majority relied on urine output, chest X-ray, arterial line, and respiratory mechanics to assess fluid status. Favored fluid removal approaches include low dose followed by high dose loop diuretic. Fluid removal is guided by net fluid balance goal (13/16). All agreed that fluid overload state negatively impacts outcomes, while 75% agreed in the setting of fluid overload state, active deresuscitation improves patient outcomes. Majority agreed that an evidence-based protocol guiding deresuscitation would be helpful, however only 1/16 respondents has a protocol to guide fluid management in ICU patients.

Conclusions: Surgical intensivists identify fluid overload state to worsen outcomes and believe active interventions can improve patient care. Most rely on clinical markers to assess fluid status and diuretics to remove excess fluid, however there is limited guidance to drive practice. Our study is an initial step to characterize the fluid management and deresuscitation practices of surgical intensivists. Further work needs to be done to establish protocolized, evidence-based care in this arena.