{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:52:36Z","timestamp":1791978756131,"version":"4.4.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"abstract":"<jats:sec id=\"ab-joi260120-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-joi260120-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize ICU fluid practices in mechanically ventilated adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-joi260120-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-joi260120-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Fluid volume, indication, and type after intubation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-joi260120-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-joi260120-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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, \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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-joi260120-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jama.2026.21291","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:32:31Z","timestamp":1791977551000},"source":"Crossref","is-referenced-by-count":0,"title":["Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients"],"prefix":"10.1001","author":[{"given":"Siebe G.","family":"Blok","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Amsterdam UMC, Amsterdam, the Netherlands"},{"name":"Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harm-Jan","family":"de Grooth","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, UMC Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Pisani","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Barbas","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Dubin","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sanatorio Otamendi, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Hammond","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health and University of New South Wales, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Kwizera","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manu L. 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