Haemodynamics, fluids & transfusion
Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients
Authors' conclusion
In this prospective international cohort study, fluid therapy varied widely among mechanically ventilated critically ill patients, with maintenance and creep fluids-rather than resuscitation fluids-accounting for most total volume.
Study context
- Population
- Consecutive adult patients receiving invasive mechanical ventilation within 3 days of intensive care unit (ICU) admission and ventilated 24 hours or more; excluded: age younger than 16 years and transfer under mechanical ventilation from another ICUpatients analyzed
- Participants
- 2,454 patients
- Outcome
- Daily fluid input
- Follow-up
- Day 1 to day 6
Methodological details206 ICUs in 41 countries on 6 continents, consecutive adult patients
- 206 ICUs in 41 countries on 6 continents
- Consecutive adult patients
Main finding
As reported in the abstract
Median daily fluid input on day 1 (peak)
3.0 L
IQR, 2.2–4.0 L
Median daily fluid input through day 6
2.6 L
IQR, 1.8–3.5 L
Observational data: associations, not effects.
Further findings
Daily fluid balance · day 1 to day 6
- Median daily fluid balance on day 1
- 0.9 L; IQR, 0.1-1.9 L
- Daily fluid balance by day 3
- less than 0.3 L (IQR, −0.5 to 1.2 L)
- Remained near-neutral through day 6
Indication for fluid therapy
- Maintenance and replacement fluids
- 31.9%
- Creep fluids
- 30.9%
- Resuscitation
- 16.0%
Fluid type
- Isotonic balanced crystalloids
- 48.9%
- Isotonic saline (0.9% sodium chloride)
- 27.0%
- Colloids
- 1.3%
Between-site variation
- Substantial between-site variation persisted after adjustment for case-mix
Original publication
Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients. JAMA. Published 14 October 2026. doi:10.
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