Fluid conservation approach to intravenous fluid shortages
Abstract:
Purpose: In September 2024, Hurricane Helene disrupted a key North Carolina facility producing 60% of medical-grade fluids in the United States, causing a nationwide intravenous fluid (IVF) shortage and prompting urgent conservation in hospitals. The impact of these efforts on patient outcomes remains poorly understood. The purpose of this study is to examine the effect of a hospital-wide fluid conservation strategy on the incidence of acute kidney injury (AKI).
Methods: A single-site retrospective study was conducted between January 1, 2024, and December 4, 2024, at an academic hospital. The hospital was exposed to a multifaceted fluid conservation intervention, including education, a tiered conservation approach, perioperative protocol change, digital interventions to support clinical decision-making, and performance monitoring and feedback. Baseline data was collected for 10 months, and intervention period data was collected for 8 weeks.
Results: In total, 21,017 hospitalizations before and 3,494 hospitalizations after the intervention were reviewed. The rate of AKI did not change significantly (17.9% vs 18.4%; P = 0.37) despite a 34% per patient-day reduction in IVF utilization (590 mL vs 388 mL). There was no statistically significant impact on the incidence of critical care admissions from a ward (23.4% vs 23.9%; P = 1.00) or mean hospital length of stay (6.8 days vs 7.2 days; P = 0.07). Mortality, the rate of dialysis, vasopressor utilization, and rapid response activations for hypotension were evaluated; however, statistical significance was not reached due to low frequency.
Conclusion: In this study, a multifaceted fluid conservation approach significantly reduced IVF utilization without a concomitant increase in patient adverse outcomes.
Reference:
Xu O, Graven P, Downs S, Orwoll B, Chintalapani A, Hudkins M, Hubel K, Chen ZJ, Eriksson C, Merkel M. Effect of a multifaceted hospital fluid conservation approach to intravenous fluid shortages on patient outcomes. Am J Health Syst Pharm. 2026 Jan 7:zxag007. doi: 10.1093/ajhp/zxag007. Epub ahead of print. PMID: 41499452.