S Goldstein1, S Bagshaw2, M Cecconi3, M Okusa4, H Wang5, J Kellum6, M Mythen7, A D Shaw8. 1. Center for Acute Care Nephrology, Nephrology and Hypertension, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, RILF2, Cincinnati, OH 45229, USA stuart.goldstein@cchmc.org. 2. University of Alberta, Edmonton, Canada. 3. St George's Hospital and Medical School, London, UK. 4. University of Virginia Health System, Charlottesville, VA, USA. 5. University of Alabama School of Medicine, Birmingham, AL, USA. 6. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 7. University College London, London, UK. 8. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract
BACKGROUND: Standard treatment practice for the hypotensive patient with poor tissue perfusion is rapid volume resuscitation; in some scenarios, such as septic shock, this is performed with targeted goal-directed endpoints within 6 h of presentation. As a result, patients often develop significant positive fluid accumulation, which has been associated with poor outcomes above certain thresholds. METHODS: The aim of the current paper is to provide guidance for active pharmacological fluid management in the patient with, or at risk for, clinically significant positive fluid balance from either resuscitation for hypovolaemic shock or acute decompensated heart failure. RESULTS: We develop rationale for pharmacological fluid management targets (prevention of worsening fluid accumulation, achievement of slow vs rapid net negative fluid balance) in the context of phases of critical illness provided in the earlier Acute Dialysis Quality Initiative 12 papers.
BACKGROUND: Standard treatment practice for the hypotensivepatient with poor tissue perfusion is rapid volume resuscitation; in some scenarios, such as septic shock, this is performed with targeted goal-directed endpoints within 6 h of presentation. As a result, patients often develop significant positive fluid accumulation, which has been associated with poor outcomes above certain thresholds. METHODS: The aim of the current paper is to provide guidance for active pharmacological fluid management in the patient with, or at risk for, clinically significant positive fluid balance from either resuscitation for hypovolaemic shock or acute decompensated heart failure. RESULTS: We develop rationale for pharmacological fluid management targets (prevention of worsening fluid accumulation, achievement of slow vs rapid net negative fluid balance) in the context of phases of critical illness provided in the earlier Acute Dialysis Quality Initiative 12 papers.
Authors: Anders Perner; John Prowle; Michael Joannidis; Paul Young; Peter B Hjortrup; Ville Pettilä Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440