2026 Southeastern Residency Conference

Title: Impact of Intravenous Fluid Shortage Mitigation Strategies on Crystalloid Utilization and Clinical Outcomes in Critically Ill Adults 

Authors: CC Gooden, Stuart Pope, Amanda Hammond, Neha Naik 

Objective: To evaluate the impact of IV fluid shortage mitigation strategies on continuous crystalloid utilization and clinical outcomes among adult ICU patients. 

Background: Hurricane Helene damaged a major U.S. IV fluid manufacturing facility in September 2024, triggering nationwide shortages. Emory Healthcare implemented multidisciplinary conservation protocols including prioritizing fluids for resuscitation, minimizing maintenance fluids, and utilizing alternative hydration strategies. 

Methods: This multicenter, retrospective chart review included adult patients (≥18 years) admitted to Emory Healthcare ICUs receiving crystalloid fluids during pre-shortage (November 2023–March 2024) and post-shortage (November 2024–March 2025) periods. Patients who were pregnant, incarcerated, or had diabetic ketoacidosis were excluded. The primary outcome was duration of continuous crystalloid infusions. Secondary outcomes included ICU and hospital length of stay, fluid substitution patterns, diuretic/albumin/vasopressor use, acute kidney injury, mortality, and mechanical ventilation duration. Non-parametric data were analyzed using Mann–Whitney U tests and categorical variables using Fisher's exact tests. 

Results: Among 100 patients (50 per group), baseline diagnoses were similar (p=0.95), with sepsis/infection most common (55%). Median IV fluid duration decreased from 11.5 days (IQR 6.3–20.8) pre-shortage to 2.0 days (IQR 1.0–4.0) post-shortage (p<0.0001; median difference 8.0 days, 95% CI [6.0–12.0]). Bolus-only resuscitation increased from 10% to 38% (OR 5.52, 95% CI [1.86–16.34]; p=0.002). No significant differences were observed in acute kidney injury or in-hospital mortality (p>0.05). 

Conclusions: Implementation of fluid conservation strategies during the national shortage was associated with significant reduction in IV fluid duration and increased use of bolus-only strategies, without observed differences in clinical outcomes. These findings suggest that reduced-duration fluid therapy may warrant further investigation in future studies. 

Self-Assessment Question: True or False: Implementation of IV fluid conservation strategies during a national shortage was associated with a reduction in continuous crystalloid infusion duration without increasing adverse clinical outcomes.