Fluid Accumulation and Deresuscitation

Abstract

AbstractOverzealous fluid administration and capillary leaks may lead to overhydration or tissue edema. The deleterious effects of tissue edema involve disruption of tissue and endothelial glycocalyx, impeding capillary and lymphatic drainage, and causing cellular hypoxia and organ dysfunction. Evidence suggests that a progressive, cumulative positive fluid balance in patients with sepsis is an independent risk factor for organ failure and death. A combination of clinical, laboratory tests (such as hematocrit, brain natriuretic peptide, and serum electrolytes), radiological (point-of-care ultrasound or imaging) and advanced hemodynamic monitor may be used to diagnose and monitor overhydration. Various strategies to avoid and correct overhydration include fluid restriction and deresuscitation. Recent evidence supports the feasibility and safety of fluid restriction after initial resuscitation. Deresuscitation is defined as the active removal of excessive fluid using pharmacological or non-pharmacological measures and was coined during the 2011 International Fluid Academy meeting. A combination of diuretics, ultrafiltration, and fluid restriction, can be used for deresuscitation along with adequate monitoring to prevent hypoperfusion.