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Jonathan A Silversides, Emmet Major, Andrew J Ferguson, Emma E Mann, Daniel F McAuley, John C Marshall, Bronagh Blackwood, Eddy Fan
BACKGROUND: It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients. PURPOSE: To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness...
October 12, 2016: Intensive Care Medicine
Oleksa Rewa, Sean M Bagshaw
Fluid therapy is the most common intervention received by acutely ill hospitalized patients; however, important questions on its optimal use remain. Its prescription should be patient and context specific, with clear indications and contradictions, and have the type, dose, and rate specified. Any fluid therapy, if provided inappropriately, can contribute unnecessary harm to patients. The quantitative toxicity of fluid therapy contributes to worse outcomes; this should prompt greater bedside attention to fluid prescription, fluid balance, development of avoidable complications attributable to fluid overload, and for the timely deresuscitation of patients whose clinical status and physiology allow active fluid mobilization...
October 2015: Critical Care Clinics
Manu L N G Malbrain, Johan Huygh, Wojciech Dabrowski, Jan J De Waele, Anneleen Staelens, Joost Wauters
The impact of a positive fluid balance on morbidity and mortality has been well established. However, little is known about how to monitor fluid status and fluid overload. This narrative review summarises the recent literature and discusses the different parameters related to bio-electrical impedance analysis (BIA) and how they might be used to guide fluid management in critically ill patients. Definitions are listed for the different parameters that can be obtained with BIA; these include among others total body water (TBW), intracellular water (ICW), extracellular water (ECW), ECW/ICW ratio and volume excess (VE)...
November 2014: Anaesthesiology Intensive Therapy
Simon J W Oczkowski, Ian Mazzetti, Maureen O Meade, Cindy Hamielec
BACKGROUND: Fluid retention is a common complication of critical illness. It typically results from large-volume fluid infusions during acute resuscitation and is worsened by hypoalbuminemia. Recognized as edema, fluid retention is important for its association with delayed weaning and increased mortality. The standard treatment is the administration of diuretics, with or without albumin. We hypothesize that intravenous 25% albumin plus furosemide, by comparison with furosemide alone, improves diuresis, oxygenation, and hemodynamic stability in the deresuscitation of critically ill, hypoalbuminemic patients...
2014: Trials
Karthik Raghunathan, William T McGee, Thomas Higgins
PURPOSE OF REVIEW: This review discusses the importance of intravenous fluid dose and composition in surgical ICU patients. On the basis of updated physiologic postulates, we suggest guidelines for the use of crystalloids and colloids. Goal-directed fluid therapy is advocated as a means for avoiding both hypovolemia and hypervolemia. RECENT FINDINGS: Integrity of the endothelial surface layer (ESL) and 'volume context' are key determinants of fluid disposition. During critical illness the ESL is compromised...
August 2012: Current Opinion in Critical Care
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