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Vol. 45. Issue 9.
Pages 552-562 (December 2021)
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Vol. 45. Issue 9.
Pages 552-562 (December 2021)
Review
Ten answers to key questions for fluid management in intensive care
Diez respuestas a preguntas clave para el manejo de fluidos en cuidados intensivos
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F. Sanfilippoa,
Corresponding author
filipposanfi@yahoo.it

Corresponding author.
, A. Messinab,c, M. Cecconib,c, M. Astutoa,d,e
a Department of Anaesthesia and Intensive Care, A.O.U. “Policlinico-Vittorio Emanuele”, Catania, Italy
b Humanitas Clinical and Research Center – IRCCS, Milano, Italy
c Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
d School of Anaesthesia and Intensive Care, University Hospital “G. Rodolico”, University of Catania, Catania, Italy
e Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy
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Table 1. Systemic effects of fluid overload.
Table 2. Assessment of tissue dysoxia at the bedside.
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Abstract

This review focuses on fluid management of critically ill patients. The topic is addressed based on 10 single questions with simplified answers that provide clinicians with the basic information needed at the point of care in treating patients in the Intensive Care Unit. The review has didactic purposes and may serve both as an update on fluid management and as an introduction to the subject for novices in critical care.

There is an urgent need to increase awareness regarding the potential risks associated with fluid overload. Clinicians should be mindful not only of the indications for administering fluid loads and of the type of fluids administered, but also of the importance to set safety limits. Lastly, it is important to implement proactive strategies seeking to establish negative fluid balance as soon as the clinical conditions are considered to be stable and the risk of deterioration is low.

Keywords:
Sepsis
Septic shock
Hemodynamic monitoring
Echocardiography
Crystalloids
Colloids
Resumen

Esta revisión se centra en el manejo de fluidos en el paciente crítico. Discutimos el tema con un enfoque basado en 10 preguntas individuales con respuestas simplificadas, que ofrecen al personal clínico la información básica necesaria, a pie de cama, para tratar a los pacientes en las unidades de cuidados intensivos. Esta revisión tiene propósitos didácticos y puede servir tanto como actualización sobre el manejo de fluidos como una introducción al tema para los que comienzan a tratar a pacientes críticos.

Existe una necesidad urgente de aumentar la conciencia sobre los riesgos potenciales asociados con la sobrecarga de líquidos. Los médicos deben tener en cuenta no solo las indicaciones para administrar una carga de fluidos, sino también el tipo de fluidos administrados y la importancia de establecer límites de seguridad. Finalmente, es necesario implementar estrategias proactivas que tengan como objetivo un balance negativo de líquidos tan pronto como las condiciones clínicas del paciente crítico se consideren estables y el riesgo de deterioro sea bajo.

Palabras clave:
Sepsis
Shock séptico
Monitoreo hemodinámico
Ecocardiografía
Cristaloides
Coloides

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