eISSN: 1731-2531
ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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2/2021
vol. 53
 
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abstract:
Review paper

Aiming for zero fluid accumulation: First, do no harm

Orlando R. Perez Nieto
1
,
Adrian Wong
2, 3
,
Jorge Lopez Fermin
1
,
Eder I. Zamarron Lopez
4
,
Jose A. Meade Aguilar
5, 6
,
Ernesto Deloya Tomas
1
,
Jorge D. Carrion Moya
1
,
Gabriela Castillo Gutierrez
1
,
Maria G. Olvera Ramos
1
,
Xiomara García Montes
7
,
Manuel Alberto Guerrero Gutiérrez
8
,
Fernando George Aguilar
9
,
Jesús Salvador Sánchez Díaz
7
,
Raúl Soriano Orozco
10
,
Eduardo Ríos Argaiz
6
,
Thierry Hernandez-Gilsoul
6
,
Roberto Secchi del Rio
1
,
Silvio Antonio Ñamendys-Silva
8
,
Manu L.N.G. Malbrain
3, 11

1.
General Hospital of San Juan del Río, Querétaro, México
2.
Department of Intensive Care Medicine, Kings’s College, London, UK
3.
International Fluid Academy, Lovenjoel, Belgium
4.
Regional General Hospital IMSS, #6. Cd. Madero, Tamps, México
5.
Faculty of Medicine, Autonomous University of San Luis Potosí, SLP, México
6.
National Institute of Medical Sciences and Nutrition “Salvador Zubirán”, CDMX, México
7.
Specialty Hospital UMAE 14 IMSS Veracruz, México
8.
National Institute of Cancerology, CDMX, México
9.
Regional Hospital of High Specialty Health City, Chiapas, México
10.
High Specialty Hospital T1, IMSS, Leon, Gto, México
11.
Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
Anaesthesiol Intensive Ther 2021; 53, 2: 162–178
Online publish date: 2021/04/13
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Critically ill patients are often presumed to be in a state of “constant dehydration” or in need of fluid, thereby justifying a continuous infusion with some form of intravenous (IV) fluid, despite their clinical data suggesting otherwise. Overzealous fluid administration and subsequent fluid accumulation and overload are associated with poorer outcomes. Fluids are drugs, and their use should be tailored to meet the patient’s individualized needs; fluids should never be given as routine maintenance unless indicated. Before prescribing any fluids, the physician should consider the patient’s characteristics and the nature of the illness, and assess the risks and benefits of fluid therapy.

Decisions regarding fluid therapy present a daily challenge in many hospital departments: emergency rooms, regular wards, operating rooms, and intensive care units. Traditional fluid prescription is full of paradigms and unnecessary routines as well as malpractice in the form of choosing the wrong solutions for maintenance or not meeting daily requirements. Prescribing maintenance fluids for patients on oral intake will lead to fluid creep and fluid overload. Fluid overload, defined as a 10% increase in cumulative fluid balance from baseline weight, is an independent predictor for morbidity and mortality, and thus hospital cost. In the last decade, increasing evidence has emerged supporting a restrictive fluid approach.

In this manuscript, we aim to provide a pragmatic description of novel concepts related to the use of IV fluids in critically ill patients, with emphasis on the different indications and common clinical scenarios. We also discuss active deresuscitation, or the timely cessation of fluid administration, with the intention of achieving a zero cumulative fluid balance.
keywords:

fluid therapy, oedema, fluid overload, solution, infusion, maintenance, resuscitation, de-escalation, deresuscitation

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