Pharmacological management of fluid overload

Area of Science:

• Critical Care Medicine
• Nephrology
• Pharmacology

Background:

• Standard hypotensive patient treatment involves rapid volume resuscitation, often leading to positive fluid balance.
• Excessive fluid accumulation is linked to adverse outcomes in critically ill patients, including those with septic shock.
• Acute decompensated heart failure also necessitates careful fluid management.

Purpose of the Study:

• To provide guidance on active pharmacological fluid management strategies.
• To address patients at risk for or experiencing significant positive fluid balance.
• To optimize fluid management in hypovolemic shock resuscitation and acute decompensated heart failure.

Main Methods:

• Developing rationale for pharmacological fluid management targets.
• Integrating fluid management with critical illness phases outlined in prior Acute Dialysis Quality Initiative (ADQI) 12 papers.
• Focusing on preventing worsening fluid accumulation and achieving slow net negative fluid balance.

Main Results:

• Rationale for pharmacological fluid management targets established.
• Strategies for prevention of worsening fluid accumulation detailed.
• Guidance for achieving slow versus rapid net negative fluid balance provided.

Conclusions:

• Pharmacological fluid management is crucial for optimizing fluid balance in critical illness.
• Targeting slow net negative fluid balance may improve patient outcomes.
• This guidance supports clinicians in managing fluid overload in high-risk patients.