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["Terminal" dehydration, part 2 : Medical indications and therapeutic approach]
U Suchner1, C Reudelsterz2, C Gog3
1Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Darmstadt, Darmstadt, Deutschland.
Der Anaesthesist
|October 28, 2018
Summary
Clinical fluid management for dying patients remains debated. This study emphasizes evidence-based therapeutic indications for clinically assisted hydration (CAH), focusing on noninvasive assessment and monitoring to individualize care.
Area of Science:
- Palliative Care
- Clinical Nephrology
- Geriatrics
Background:
- Fluid management in dying patients is controversial, lacking robust evidence.
- Distinguishing reversible dehydration from irreversible terminal dehydration is critical.
Purpose of the Study:
- To emphasize the importance of evidence-based therapeutic indications for fluid management in the dying.
- To present methods for noninvasive assessment of dehydration and its reversibility.
- To highlight the necessity of continuous monitoring during clinically assisted hydration.
Main Methods:
- Review of pathophysiological mechanisms of fluid homeostasis disorders.
- Discussion of noninvasive techniques for assessing hydration status.
- Emphasis on individualized assessment and continuous monitoring of therapeutic interventions.
Main Results:
- Lack of evidence necessitates clear therapeutic indications for fluid management.
- Noninvasive methods can objectify assumed dehydration and assess symptom reversibility.
- Continuous monitoring is crucial for adjusting hydration therapy.
Conclusions:
- Therapeutic indications for fluid management in the dying must be established based on evidence.
- Individualized assessment and noninvasive monitoring are essential for effective clinically assisted hydration (CAH).
- Distinguishing reversible from irreversible fluid disorders guides appropriate interventions.