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Updated: Aug 30, 2026

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
How should diuretic-refractory, volume-overloaded heart failure patients be managed?
Jonathan D Sackner-Bernstein1, Rimvida Obeleniene
1Division of Cardiology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA. jsbernst@nshs.edu
Abstract:
Hospitalization is often required for patients with decompensated heart failure, usually with volume overload. Intravenous diuretics are recommended to optimize volume status; however, the management of patients refractory to diuretic therapy is not addressed in American Heart Association/American College of Cardiology, European Society of Cardiology or Heart Failure Society of America guidelines. This review focuses the invasive/interventional cardiologist on the rationale for greater involvement in the care of patients admitted to the hospital with decompensated volume overload, in particular when such patients are diuretic refractory.
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