Bibliographic information
Guideline—
Year of Publication—
Issuing Institution—
Recommendation
New
WHO recommends balanced crystalloids (such as Ringer’s lactate) rather than 0.9% sodium chloride for acute intravenous fluid resuscitation in patients with suspected or confirmed filovirus disease.
Recommended in favor
Strong
Certainty of evidence
Moderate
Notes and Remarks
- This applies to children and adults including pregnant women, who have sepsis, septic shock and/or dehydration.
- Conditions where 0.9% sodium chloride may be preferred include patients with filovirus disease that have trauma including traumatic brain injury. Practical info Volume of fluid to be administered This recommendation should be applied in the context of others, including those related to vasopressor initiation and monitoring of fluid response. As for all medications, fluid should be prescribed at a dose (volume) and strength (concentration), route and duration. Titration of the dose should be frequently reviewed, especially during critical phases of resuscitation where the therapeutic window is narrow (that is, under- or over-dosing is easily possible without careful attention and review). Previously, a fluid volume of 30 mL/kg was used as an initial guide within the first 3 hours of resuscitation, but individualized therapy is key. Clinicians should aim to use fluid volumes which minimize avoidable end-organ hypoperfusion injury and do not provoke clinically significant oedema (notably pulmonary oedema). Frequent monitoring and re-evaluation are necessary which take into consideration pre-existing comorbidity, and tailor each additional fluid intervention. In general terms, smaller and more frequent volumes of fluid (e.g. 250 mL) are appropriate, and this requires high staff:patient ratios. Uses of fluids apart from intravascular volume expansion Normal saline is frequently the necessary diluent for medications, or for flushing lines. This is because of potential pH changes, or precipitation of salts associated with balanced crystalloids, which can be harmful. Use only the recommended fluid to reconstitute or dilute medications.