JAMA
October 14, 2026 · via Europe PMC
Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients.
Blok SG, de Grooth HJ, Pisani L, +19 more, PRoFLUID Investigators.
AI summary — for doctors, generated from the abstract only
Fluid therapy in ventilated ICU patients varies widely between sites, and maintenance and creep fluids make up most of the volume rather than resuscitation fluids.
What was studied
An international prospective observational cohort of 2454 mechanically ventilated adults across 206 ICUs in 41 countries (April 2024 to July 2025), describing volume, indication, and type of fluids.
Key findings
- Median daily fluid input peaked at 3.0 L on day 1 and declined to 2.6 L through day 6; daily balance fell from 0.9 L on day 1 to near-neutral by day 3
- Maintenance and replacement fluids (31.9%) and creep fluids (30.9%) were the main indications, with resuscitation at 16.0%
- Isotonic balanced crystalloids (48.9%) and saline (27.0%) were common while colloids were rare (1.3%); between-site variation persisted after case-mix adjustment
Clinical relevance
Highlights hidden fluid sources such as drug carriers and line flushes as targets for fluid stewardship.
Who should care
Limitations
Observational with no outcome comparisons, so it cannot say which practices are best.
Creep and maintenance fluids dominate ICU fluid exposure, and practice varies substantially.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Importance
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.
Objective
To characterize ICU fluid practices in mechanically ventilated adults.
Design, setting, and participants
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.
Exposures
Fluid volume, indication, and type after intubation.
Main outcomes and measures
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.
Results
Among 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, -0.5 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.
Conclusions and relevance
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.
DOI
10.1001/jama.2026.21291
PMID
42872606
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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