Author's response: “What is meant by “fluid tolerance”?”

• Published in: Journal of critical care Vol. 72; p. 154158
• Main Authors: Kattan, Eduardo, Castro, Ricardo, Miralles-Aguiar, Francisco, Hernández, Glenn, Rola, Philippe
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01-12-2022; Elsevier Limited
• Subjects: Critical care; Fluids; Sepsis
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2022.154158

[...]we completely agree with the author that organ dysfunction during critical illness is a multilayered problem, and no single component can be pinpointed (i.e., fluids) as the sole determinant of its' evolution. [...]we count with clinical evidence that support the idea that fluid administration in high-risk patients may deleteriously impact organ function during the resuscitation phase. [...]pretending to develop a more granular definition or score of such a complex phenomenon has the inherent risks of oversimplification, reductionism, and rapid obsolescence. Contemporary literature also supports the idea of fluids administration in sepsis, since both early vasopressor studies [11,12], as well as restrictive fluid studies [13], have still administered fluids as an initial resuscitative intervention. [...]aiming to provide a more rational and multimodal resuscitation does not imply to pursue a fluid-free strategy, since altered vasomotor tone is not the only pathological determinant of circulatory dysfunction in sepsis.