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2016 ; 2
(2
): 64-71
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Fluid Management for Critically Ill Patients: A Review of the Current State of
Fluid Therapy in the Intensive Care Unit
#MMPMID27536694
Frazee E
; Kashani K
Kidney Dis (Basel)
2016[Jun]; 2
(2
): 64-71
PMID27536694
show ga
BACKGROUND: Intravenous fluids (IVF) are frequently utilized to restore
intravascular volume in patients with distributive and hypovolemic shock.
Although the benefits of the appropriate use of fluids in intensive care units
(ICUs) and hospitals are well described, there is growing knowledge regarding the
potential risks of volume overload and its impact on organ failure and mortality.
To avoid volume overload and its associated complications, strategies to identify
fluid responsiveness are developed and utilized more often among ICU patients.
Apart from the amount of fluid utilized for resuscitation, the type of fluid used
also impacts patient outcome. Colloids and crystalloids are two types of fluids
that are utilized for resuscitation. The efficacy of each fluid type on the
expansion of intravascular volume on one hand and the potential adverse effects
of each individual fluid, on the other hand, need to be considered when choosing
the type of fluid for resuscitation. The negative impact of hydroxyethyl starch
on kidney function, of albumin on the mortality of head trauma patients and
chloride-rich crystalloids on mortality and kidney function, are only examples of
new developments in the field. SUMMARY: In this paper, we will review the impact
of fluid overload on patient outcomes, define the fluid challenge, describe the
differences in static and dynamic estimates of fluid responsiveness, and review
the effect of different types of fluid on patient outcome. KEY MESSAGE: Avoiding
fluid overload by choosing the appropriate amount of fluids in patients who are
fluid-responsive on one hand, and treating IVF like other medications, on the
other hand, are the major changes. Whenever clinicians decide to prescribe IVF,
they need to weigh the risks and benefits of giving fluid and also the advantages
and side effects of each fluid type in order to optimize patient outcomes.