Abstract
BackgroundThis review is a “Pro-Con” discussion about the optimal fluid volume in critically ill patients in the intensive care unit (ICU). This article argues that fluids should be aggressively managed in critically ill patients.Main bodyIn recent years, restrictive fluid management has been thought to be beneficial for critically ill patients. Thus, to investigate whether fluid volumes have actually been restricted in practice, fluid volumes were compared between those used in the early goal-directed therapy (EGDT) study by Rivers et al. performed in 2001 and those used in the Protocolized Care for Early Septic Shock (ProCESS), Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolized Management in Sepsis (ProMISe) studies performed between 2014 and 2015. The later studies did not have lower total fluid volumes than those in the EGDT study. This finding shows that the importance of administering a sufficient fluid volume before admission to the ICU has become widely accepted.Fluid management strategies for critically ill patients can be divided into the following four phases: rescue (or salvage), optimization, stabilization, and de-escalation. Fluid therapy administered within 6 h of presentation covers the rescue and optimization phases. Because hemodynamic instability is observed in these phases, sufficient fluid should be administered for lifesaving and organ rescue purposes. As a strategy, water may be removed during the hemodynamically stable later phase after sufficient fluid volumes were given during the hemodynamically instable early phase.ConclusionsPerforming aggressive fluid management is important to infuse a sufficient fluid volume proactively during the hemodynamically instable early phase of a critical illness.
Highlights
This review is a “Pro-Con” discussion about the optimal fluid volume in critically ill patients in the intensive care unit (ICU)
Fluid volumes were compared between the early goal-directed therapy (EGDT) study performed by Rivers et al in 2001 [3] and the Protocolized Care for Early Septic Shock (ProCESS) [4], Australasian Resuscitation in Sepsis Evaluation (ARISE) [5], and Protocolized Management in Sepsis (ProMISe) [6] studies performed between 2014 and 2015 to investigate whether fluid volume has become restricted (Table 1)
Even if blood pressure is normal based on vasopressor use, cryptic shock caused by hypovolemia may remain; it is important to administer a sufficient fluid volume
Summary
This review is a “Pro-Con” discussion about the optimal fluid volume in critically ill patients in the intensive care unit (ICU). Conclusions: Performing aggressive fluid management is important to infuse a sufficient fluid volume proactively during the hemodynamically instable early phase of a critical illness. Fluid volumes were compared between the early goal-directed therapy (EGDT) study performed by Rivers et al in 2001 [3] and the Protocolized Care for Early Septic Shock (ProCESS) [4], Australasian Resuscitation in Sepsis Evaluation (ARISE) [5], and Protocolized Management in Sepsis (ProMISe) [6] studies performed between 2014 and 2015 to investigate whether fluid volume has become restricted (Table 1).
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