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Updated: Jan 29, 2026
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Clinical Parameters Associated with Achieving Negative Fluid Balance in Critically Ill Patients: A Retrospective
Dekel Stavi1,2, Amir Gal Oz1,2, Nimrod Adi1,2
1Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel.
Journal of Clinical Medicine
|January 28, 2026
Summary
Mean arterial pressure (MAP) is key for fluid removal in critically ill patients. Higher MAP improves diuretic response, while vasopressors, kidney issues, and illness severity hinder fluid balance.
Area of Science:
- Critical Care Medicine
- Nephrology
- Pharmacology
Background:
- Fluid overload in critically ill patients is a significant contributor to adverse outcomes.
- Limited guidance exists for the de-resuscitation phase, contrasting with established resuscitation protocols.
- Identifying factors influencing diuretic response is crucial for optimizing patient management.
Purpose of the Study:
- To identify clinical factors associated with diuretic response in critically ill patients.
- To determine predictors of achieving negative fluid balance (FB) during the de-resuscitation phase.
Main Methods:
- Retrospective cohort study of 1764 ICU patients receiving intravenous furosemide (2017-2023).
- CHAID decision tree analysis to identify variables linked to fluid removal post-furosemide.
- Mixed-effects modeling to analyze repeated fluid balance measurements.
Main Results:
- Mean arterial pressure (MAP) was the strongest predictor of negative FB.
- Higher MAP levels correlated with significantly greater fluid removal (MAP > 90 mmHg: -899 mL/24h).
- Vasopressor use, elevated creatinine, and higher SOFA scores were independently associated with reduced negative FB.
Conclusions:
- MAP significantly influences the ability to achieve negative fluid balance during de-resuscitation.
- Diuretic responsiveness is diminished by vasopressor therapy, renal dysfunction, and increased illness severity.
- Findings support the development of individualized de-resuscitation strategies based on patient MAP and clinical status.
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