{"id":31947,"date":"2026-10-24T04:51:00","date_gmt":"2026-10-23T20:51:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=31947"},"modified":"2026-10-24T12:41:37","modified_gmt":"2026-10-24T04:41:37","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%8e%a5%e5%8f%97%e6%9c%ba%e6%a2%b0%e9%80%9a%e6%b0%94%e7%9a%84%e9%87%8d%e7%97%87%e6%88%90%e5%b9%b4%e6%82%a3%e8%80%85%e7%9a%84%e6%b6%b2%e4%bd%93","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=31947","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u7684\u91cd\u75c7\u6210\u5e74\u60a3\u8005\u7684\u6db2\u4f53\u6cbb\u7597"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients<\/h1>\n\n\n\n

Siebe G.\u00a0Blok,\u00a0Harm-Jan\u00a0de Grooth,\u00a0Luigi\u00a0Pisani,\u00a0et al<\/h3>\n\n\n\n

JAMA Published Online:\u00a0October\u00a014,\u00a02026<\/h3>\n\n\n\n

doi: 10.1001\/jama.2026.21291<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  How is fluid therapy administered in mechanically ventilated critically ill patients?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 2454 mechanically ventilated adults in 41 countries, median daily fluid input was 3.0 L on the first day of intubation with neutral fluid balance after day 3. Maintenance accounted for 32% and creep fluid (to deliver medications and maintain catheter patency) accounted for 31%; resuscitation fluid accounted for 16%, and substantial variation in fluid therapy across sites persisted after case-mix adjustment.<\/p>\n\n\n\n

Meaning<\/strong>  These findings highlight opportunities for harmonizing fluid therapy across centers and extend fluid stewardship beyond resuscitation to maintenance and creep fluids.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Fluid therapy is ubiquitous in the intensive care unit (ICU) but carries risks, especially in mechanically ventilated patients. Contemporary global practice across dose, indication, and type is unknown.<\/p>\n\n\n\n

Objective<\/strong>  To characterize ICU fluid practices in mechanically ventilated adults.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  International prospective observational cohort study between April 2024 and July 2025, across 206 ICUs in 41 countries on 6 continents. Consecutive adult patients receiving invasive mechanical ventilation within 3 days of ICU admission and ventilated 24 hours or more. Exclusion criteria were age younger than 16 years and transfer under mechanical ventilation from another ICU.<\/p>\n\n\n\n

Exposures<\/strong>  Fluid volume, indication, and type after intubation.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Key measures included (1) total infused volume and daily fluid balance over 7 days after intubation; (2) the indication for fluid therapy over the first 3 days after intubation; (3) the proportion of total administered fluid volume attributable to each fluid type over the first 3 days after intubation.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 2454 patients analyzed (median age, 63 years [IQR, 49-73 years]; 63.6% [1560] male), median daily fluid input peaked on day 1 at 3.0 L (IQR, 2.2-4.0 L) and declined to 2.6 L (IQR, 1.8-3.5 L) through day 6. Daily fluid balance (median, 0.9 L; IQR, 0.1-1.9 L on day 1) decreased to less than 0.3 L (IQR, \u22120.5 to 1.2 L) by day 3 and remained near-neutral through day 6. Maintenance and replacement fluids (to meet daily requirements and to correct ongoing losses; 31.9%) and creep fluids (to deliver medications and maintain catheter patency; 30.9%) were the primary indications, whereas resuscitation (to restore circulating blood volume; 16.0%) accounted for a smaller proportion. Isotonic balanced crystalloids (48.9%) and isotonic saline (0.9% sodium chloride) (27.0%) were common; colloids were rare (1.3%). Substantial between-site variation persisted after adjustment for case-mix.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this prospective international cohort study, fluid therapy varied widely among mechanically ventilated critically ill patients, with maintenance and creep fluids\u2014rather than resuscitation fluids\u2014accounting for most total volume.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31947"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31947"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31947\/revisions"}],"predecessor-version":[{"id":31948,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31947\/revisions\/31948"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31947"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31947"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31947"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}