title: Pharmacological management of fluid overload.
abstract: BACKGROUND
  Standard treatment practice for the hypotensive patient with poor tissue perfusion is rapid volume resuscitation; in some scenarios, such as septic shock, this is performed with targeted goal-directed endpoints within 6 h of presentation. As a result, patients often develop significant positive fluid accumulation, which has been associated with poor outcomes above certain thresholds.
  
  
  METHODS
  The aim of the current paper is to provide guidance for active pharmacological fluid management in the patient with, or at risk for, clinically significant positive fluid balance from either resuscitation for hypovolaemic shock or acute decompensated heart failure.
  
  
  RESULTS
  We develop rationale for pharmacological fluid management targets (prevention of worsening fluid accumulation, achievement of slow vs rapid net negative fluid balance) in the context of phases of critical illness provided in the earlier Acute Dialysis Quality Initiative 12 papers.
authors.affiliation: Center for Acute Care Nephrology, Nephrology and Hypertension, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, RILF2, Cincinnati, OH 45229, USA stuart.goldstein@cchmc.org.
authors.forename: S
authors.initials: S
authors.lastname: Goldstein
authors.affiliation: University of Alberta, Edmonton, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Bagshaw
authors.affiliation: St George's Hospital and Medical School, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Cecconi
authors.affiliation: University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Okusa
authors.affiliation: University of Alabama School of Medicine, Birmingham, AL, USA.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kellum
authors.affiliation: University College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Mythen
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Shaw
mesh_terms: D003422:Critical Care; D003697:Delphi Technique; D004232:Diuretics / Q000627:therapeutic use; D005440:Fluid Therapy / Q000009:adverse effects*; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D010477:Perfusion; D012151:Resuscitation; D012769:Shock / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D004232:Diuretics
keywords: acute kidney injury; fluid overload; medications