@Article{Perez Nieto2021,
journal="Anestezjologia Intensywna Terapia",
issn="0209-1712",
year="2021",
title="Aiming for zero fluid accumulation: First, do no harm",
abstract="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.",
author="Perez Nieto, Orlando R.
and Wong, Adrian
and Lopez Fermin, Jorge
and Zamarron Lopez, Eder I.
and Meade Aguilar, Jose A.
and Deloya Tomas, Ernesto
and Carrion Moya, Jorge D.
and Castillo Gutierrez, Gabriela
and G. Olvera Ramos, Maria
and García Montes, Xiomara
and Alberto Guerrero Gutiérrez, Manuel
and George Aguilar, Fernando
and Salvador Sánchez Díaz, Jesús
and Soriano Orozco, Raúl
and Ríos Argaiz, Eduardo
and Hernandez-Gilsoul, Thierry
and Secchi del Rio, Roberto
and Ñamendys-Silva, Silvio Antonio
and L.N.G. Malbrain, Manu",
pages="162--178",
url="https://www.termedia.pl/Aiming-for-zero-fluid-accumulation-First-do-no-harm,144,44608,1,1.html"
}