Aggressive fluid management in the critically ill: Pro
Tóm tắt
This 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. In 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. Performing aggressive fluid management is important to infuse a sufficient fluid volume proactively during the hemodynamically instable early phase of a critical illness.
Tài liệu tham khảo
O’Connor ME, Prowle JR. Fluid overload. Crit Care Clin. 2015;31(4):803–21.
Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy collaborative group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.
ProCESS Investigators YDM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–93.
ARISE Investigators PSL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496–506.
Investigators PMIST, Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301–11.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock:2016. Intensive Care Med. 2017;43(3):304–77.
Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, Kellum JA, Mythen MG, Shaw AD, ADQI XII Investigators Group. Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth. 2014;113(5):740–7.
Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726–34.
Murphy CV, Schramm GE, Doherty JA, Reichley RM, Gajic O, Afessa B, Micek ST, Kollef MH. The importance of fluid management in acute lung injury secondary to, septic shock. Chest. 2009;136(1):102–9.
Emergency Medicine Shock Research Network (EMSHOCKNET), Puskarich MA, Trzeciak S, Shapiro NI, Heffner AC, Kline JA, Jones AE. Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock. Resuscitation. 2011;82(10):1289–93.
National Heart, Lung, and blood institute acute respiratory distress syndrome (ARDS) clinical trials network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75.