title: Indications and management of mechanical fluid removal in critical illness.
abstract: BACKGROUND
  The Acute Dialysis Quality Initiative (ADQI) dedicated its Twelfth Consensus Conference (2013) to all aspects of fluid therapy, including the management of fluid overload (FO). The aim of the working subgroup 'Mechanical fluid removal' was to review the indications, prescription, and management of mechanical fluid removal within the broad context of fluid management of critically ill patients.
  
  
  METHODS
  The working group developed a list of preliminary questions and objectives and performed a modified Delphi analysis of the existing literature. Relevant studies were identified through a literature search using the MEDLINE database and bibliographies of relevant research and review articles.
  
  
  RESULTS
  After review of the existing literature, the group agreed the following consensus statements: (i) in critically ill patients with FO and with failure of or inadequate response to pharmacological therapy, mechanical fluid removal should be considered as a therapy to optimize fluid balance. (ii) When using mechanical fluid removal or management, targets for rate of fluid removal and net fluid removal should be based upon the overall fluid balance of the patient and also physiological variables, individualized, and reassessed frequently. (iii) More research on the role and practice of mechanical fluid removal in critically ill patients not meeting fluid balance goals (including in children) is necessary.
  
  
  CONCLUSIONS
  Mechanical fluid removal should be considered as a therapy for FO, but more research is necessary to determine its exact role and clinical application.
authors.affiliation: Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Rosner
authors.affiliation: Department of Critical Care Medicine, King's College London, King's Health Partners, Guy's and St Thomas' Foundation Hospital, London SE1 7EH, UK marlies.ostermann@gstt.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Ostermann
authors.affiliation: The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Murugan
authors.affiliation: Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Prowle
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ronco
authors.affiliation: The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: University College London Hospital and University College London NIHR Biomedical Research Centre, London, UK.
authors.forename: M G
authors.initials: MG
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: D016638:Critical Illness / Q000628:therapy*; D003956:Dialysis; D005440:Fluid Therapy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D014462:Ultrafiltration; D014511:Uremia / Q000209:etiology / Q000628:therapy; D014882:Water-Electrolyte Balance / Q000187:drug effects; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000188:drug therapy
keywords: fluid balance; fluid therapy; kidney failure