Individualized de-resuscitation and diuresis strategies in hospitalized patients: A narrative review

The purpose of this narrative review is to survey the use of diuretic therapy in hospitalized patients with the goal of synthesizing relevant data and describing common strategies for the individualized management of diuresis and de-resuscitation.

Careful fluid management is essential for optimizing patient-centered outcomes in hospitalized patients, particularly in those with critical illness. Intravenous fluids are one of the most commonly administered medications in hospitalized patients, but fluids are not benign. Fluid overload is associated with significant adverse events; therefore, the need for fluid stewardship has been recognized in recent years. The majority of research has been devoted to the selection and dosing of fluids in the resuscitation phase to achieve hemodynamic stability. Yet, achieving subsequent euvolemia through de-resuscitation efforts is vital for patient outcomes. Individualization of care and precision medicine are increasingly recognized as important due to the inherent heterogeneity of hospitalized patients. While general de-resuscitation guidance has been developed, a detailed review of the pharmacological management of de-resuscitation (ie, diuretics) in hospitalized patients with the goal to improve diuretic selection and implementation has not been undertaken.

Consideration of acute and chronic comorbidities is necessary to properly manage diuretics for de-resuscitation in hospitalized patients, particularly in those with critical illness. More research is needed to determine optimal strategies for individualizing de-resuscitation.