Friday, January 09, 2015

Principles of IV fluid therapy

This review conceptualizes four phases of fluid therapy in critically ill patients:

The framework recently proposed by Vincent and De Backer16 recognizes four distinct phases or stages of resuscitation: Rescue, Optimization, Stabilization, and De-escalation (ROS-D)...

The Rescue phase anticipates an immediate escalation of fluid therapy, for resuscitation of the patient with life-threatening shock (characterized by low arterial pressure, signs of impaired perfusion, or both), and characterized by the use of fluid bolus therapy (see Box 2). In Optimization, the patient is no longer in immediate life-threatening danger but is in a stage of compensated shock (but at high risk of decompensation) and any additional fluid therapy is given more cautiously, and titrated with the aim of optimizing cardiac function to improve tissue perfusion with ultimate goal of mitigating organ dysfunction. The workgroup felt strongly that a clear distinction had to be made between a ‘fluid bolus’, that is, large volume given rapidly to rescue, without close monitoring, and a ‘fluid challenge’ …

Stabilization reflects the point at which a patient is in a steady state so that fluid therapy is now only used for ongoing maintenance …

Finally, while in the first three stages (‘SOS’), fluids are usually administered, in the last stage (D), fluids will also be removed from the patient and usually, the goal will be to promote a negative fluid balance (Fig. 2)...

The first two components in this model were lumped together in the three phase concept I recently discussed here. Both models emphasize that in the final phase fluid is removed in order to restore neutral balance, either passively or with the use of diuretics.

Via Intensive Care Medicine-Working Knowledge.

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