Aiming for zero fluid accumulation: First, do no harm

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 fl...

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Published in:	Anaesthesiology intensive therapy : official publication of the Polish Society of Anaesthesiology and Intensive Therapy Vol. 53; no. 2; pp. 162 - 178
Main Authors:	Perez Nieto, Orlando R, Wong, Adrian, Lopez Fermin, Jorge, Zamarron Lopez, Eder I, Meade Aguilar, Jose A, Deloya Tomas, Ernesto, Carrion Moya, Jorge D, Castillo Gutierrez, Gabriela, G Olvera Ramos, Maria, García Montes, Xiomara, Alberto Guerrero Gutiérrez, Manuel, George Aguilar, Fernando, Salvador Sánchez Díaz, Jesús, Soriano Orozco, Raúl, Ríos Argaiz, Eduardo, Hernandez-Gilsoul, Thierry, Secchi Del Rio, Roberto, Ñamendys-Silva, Silvio Antonio, L N G Malbrain, Manu
Format:	Journal Article
Language:	English
Published:	Poland Termedia sp. z o.o 01-01-2021 Termedia Publishing House
Subjects:	Cardiac arrhythmia Cholera Critical Illness de-escalation deresuscitation Electrolytes fluid overload Fluid Therapy Fluids Heart rate Humans Hyperkalemia infusion Intensive Care Units Ischemia maintenance Medical prognosis Mortality Nutrition oedema Parenteral nutrition Patients Pharmaceutical Preparations resuscitation Review Sepsis Skin solution Water-Electrolyte Balance oedema infusion solution fluid overload deresuscitation de-escalation fluid therapy resuscitation maintenance
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 Members of group AVENTHO for the research in mechanical ventilation First and second author equally contributed to the work.
ISSN:	1642-5758 1731-2531
DOI:	10.5114/ait.2021.105252