Fluid Stewardship in Veterinary Medicine

Intravenous fluids are the most commonly administered drugs in hospitalized patients, but under- or over-administration significantly increase patient-risk. Fluid overload (FO) in people, is associated with longer hospitalization, increased mechanical ventilation, acute kidney injury and up to 70% increased mortality.

This has led to the new trend of implementing fluid stewardship programs in human hospitals. The approach is derived from experiences with antibiotic stewardship. The primary goal of fluid stewardship is to provide fluid safety guidelines for each institution by viewing fluids as drugs that require a prescription with the goal of improving patient outcomes. It is a conceptual framework for research, education and guidelines around appropriate selection, dosing, duration, de-escalation, and monitoring of fluid therapy. It also promotes four distinct phases of fluid therapy within the ROSE concept (resuscitation, optimization, stabilization, evacuation).

Fluid stewardship is a multidisciplinary team effort and involves most specialties, nursing staff and all clinicians who prescribe IV-fluid therapy. A fluid stewardship program can reduce patient complication rates, hospitalization time and mortality but monetary effects have been described as well.

Information on FO in companion animals is scarce and the concept of fluid stewardship has not been described. The goal of this presentation is to explore the most recent literature on fluid therapy and -stewardship practices in human medicine as well as existing small animal literature and to discuss the approach to implementing a fluid stewardship program in a veterinary hospital setting.