Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

被引:0
作者
Manu L. N. G. Malbrain
Thomas Langer
Djillali Annane
Luciano Gattinoni
Paul Elbers
Robert G. Hahn
Inneke De laet
Andrea Minini
Adrian Wong
Can Ince
David Muckart
Monty Mythen
Pietro Caironi
Niels Van Regenmortel
机构
[1] University Hospital Brussels (UZB),Department of Intensive Care Medicine
[2] Vrije Universiteit Brussel (VUB),Faculty of Medicine and Pharmacy
[3] International Fluid Academy,School of Medicine and Surgery
[4] Milano-Bicocca University,Department of Anesthesia and Critical Care
[5] ASST Grande Ospedale Metropolitano Niguarda,General Intensive Care Unit, Raymond Poincaré Hospital (GHU APHP Université Paris Saclay), U1173 Inflammation & Infection, School of Medicine Simone Veil
[6] UVSQ-University Paris Saclay,Emergency and Intensive Care Medicine
[7] University of Göttingen,Department of Intensive Care Medicine
[8] Amsterdam UMC,Department of Intensive Care Medicine
[9] Location VUmc,Department of Intensive Care Medicine and Anaesthesia
[10] Karolinska Institutet at Danderyds Hospital (KIDS),Department of Intensive Care Medicine, Laboratory of Translational Intensive Care Medicine, Erasmus MC
[11] Ziekenhuis Netwerk Antwerpen,Department of Surgery, Nelson R Mandela School of Medicine
[12] ZNA Stuivenberg,Level I Trauma Unit and Trauma Intensive Care Unit
[13] King’s College Hospital,University College London Hospitals
[14] University Medical Center Rotterdam,SCDU Anestesia e Rianimazione
[15] University of KwaZulu-Natal,Dipartimento di Oncologia
[16] Inkosi Albert Luthuli Central Hospital,Department of Intensive Care Medicine
[17] National Institute of Health Research Biomedical Research Centre,undefined
[18] Azienda Ospedaliero-Universitaria S. Luigi Gonzaga,undefined
[19] Università degli Studi di Torino,undefined
[20] Ziekenhuis Netwerk Antwerpen,undefined
[21] ZNA Stuivenberg,undefined
来源
Annals of Intensive Care | / 10卷
关键词
Fluid therapy; Intensive care units; Resuscitation; Maintenance; Water–electrolyte balance; Goal-directed; Crystalloids; Acid base; Sodium; Chloride;
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摘要
Intravenous fluid administration should be considered as any other pharmacological prescription. There are three main indications: resuscitation, replacement, and maintenance. Moreover, the impact of fluid administration as drug diluent or to preserve catheter patency, i.e., fluid creep, should also be considered. As for antibiotics, intravenous fluid administration should follow the four Ds: drug, dosing, duration, de-escalation. Among crystalloids, balanced solutions limit acid–base alterations and chloride load and should be preferred, as this likely prevents renal dysfunction. Among colloids, albumin, the only available natural colloid, may have beneficial effects. The last decade has seen growing interest in the potential harms related to fluid overloading. In the perioperative setting, appropriate fluid management that maintains adequate organ perfusion while limiting fluid administration should represent the standard of care. Protocols including a restrictive continuous fluid administration alongside bolus administration to achieve hemodynamic targets have been proposed. A similar approach should be considered also for critically ill patients, in whom increased endothelial permeability makes this strategy more relevant. Active de-escalation protocols may be necessary in a later phase. The R.O.S.E. conceptual model (Resuscitation, Optimization, Stabilization, Evacuation) summarizes accurately a dynamic approach to fluid therapy, maximizing benefits and minimizing harms. Even in specific categories of critically ill patients, i.e., with trauma or burns, fluid therapy should be carefully applied, considering the importance of their specific aims; maintaining peripheral oxygen delivery, while avoiding the consequences of fluid overload.
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