Evidence-based fluid management in the ICU

Current Opinion in Anaesthesiology
Achim W Schindler, Gernot Marx

Abstract

Evidence-based fluid therapy is complicated by blurred boundaries toward other fields of therapy and the majority of trials not focusing on patient-relevant outcomes. Additionally, recent trials unsettled the faith in traditional concepts on fluid therapy. The article reviews the evidence on diagnosis and treatment of hypovolemia and discusses the use of balanced solutions and early goal-directed therapy (EGDT) in septic shock resuscitation. Hypovolemia should be diagnosed and its treatment guided by a multifaceted approach, including medical history, physical examination, volume responsiveness, and technical parameters - dynamic indicators, volumetric indicators, sonography, and metabolic indicators. Central venous pressure and pulmonary artery occlusion pressure should be avoided. In ICU patients, balanced crystalloids should primarily be used, because unbalanced infusions (especially saline) cause hyperchloremic acidosis which is associated with renal impairment and infections. Colloids are beneficial to restore blood volume rapidly. Hydroxyethyl starch may be harmful although the validity of the respective recent studies is limited by methodological flaws. Early aggressive fluid therapy is still beneficial in septic shock r...Continue Reading

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Nov 18, 2017·Journal of Clinical Monitoring and Computing·Marko ZlicarMaurizio Cecconi
Jan 26, 2018·Critical Care : the Official Journal of the Critical Care Forum·Maria Helena Calixto FernandesRoupen Hatzakorzian
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Dec 24, 2018·BMC Anesthesiology·Claude MartinSharon Einav

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Methods Mentioned

BETA
amputation

Software Mentioned

EGDT
ProCESS
SPLIT
ARISE
ProMISe

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