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[Fluid overload in critically ill patients. Hemodynamic effect vs hydrosaline balance]
1División Terapia Intensiva, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires. cbiancolin@intramed.net.ar
Medicina
|June 3, 2000
Summary
High-volume fluid resuscitation in critically ill patients may not improve outcomes and can cause fluid overload. Restricted fluid protocols preserving fluid balance are encouraged for potentially better patient results.
Area of Science:
- Critical Care Medicine
- Fluid Resuscitation Physiology
Context:
- Critically ill patients often receive high-volume fluid resuscitation based on expert recommendations.
- These protocols aim to expand volume and optimize oxygen delivery, especially in conditions like sepsis, trauma, and surgery.
- However, the underlying conditions are not always characterized by hypovolemia.
Purpose:
- To review the evidence and mechanisms behind fluid administration in critical care.
- To question the efficacy of volume expansion when hypovolemia is not the primary issue.
- To explore the reasons for water and sodium retention in critically ill patients.
Summary:
- Current expert recommendations for high-volume fluid resuscitation in critically ill patients are questioned.
- Treatments aimed at supranormal oxygen delivery have shown no benefit in morbidity and mortality rates.
- These approaches fail to correct arterial vasodilation and lead to fluid overload, while restricted fluid protocols are encouraged.
Impact:
- Highlights the potential harm of aggressive fluid administration in critical care.
- Suggests a shift towards fluid-restricted protocols to improve patient outcomes.
- Encourages further research into the mechanisms of fluid and sodium retention in critical illness.