Fig. 4

Patient View: Intake & Output (I&O). a The patient above has the I and O balance background of red because the calculated balance is ≥ 40% of the EBV positive, + 4828. When the I&O Balance button is opened, the window shows the itemization of the calculated balance, (b). This incorporates inputs of fluid minus outputs of fluid (losses). Losses are made up of insensible losses, estimated blood loss, urine output, and potential third-space surgical losses. The fluid balance is based on crystalloid, therefore, blood lost and blood transfused is weighted by three and albumin by 1.5. The insensible loss is calculated using the 4–2-1 rule and assumes 8 h of NPO. If that assumption is incorrect because the NPO time is different or the patient has had intravenous fluids, then that time can be corrected by opening the NPO scroll bar and picking the accurate NPO hours. If the patient is at a neutral fluid balance (in the opinion of the provider), the normalized button can be hit and the I&O calculation will be reset to zero. Note: the amount of fluid “normalized away”, either added or subtracted, is displayed on the far right end of the I&O calculation line. c The surgical “third-space loss” can range from 0 to 7 ml/kg/h depending on which level the user selects. Because most cases have relatively little third-space loss due to exposed surgical wounds and trauma, the default is set to zero. When the I&O window is open there is a user selection drop down menu for various levels of third-space loss, in this case severe = 7 ml/kg/h