title: Fluid Therapy: Double-Edged Sword during Critical Care?
abstract: Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University Teaching Hospital and Faculty of Medicine in Plzen, Charles University Prague, Alej Svobody 80, 32300 Plzen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Benes
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk 163000, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kirov
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk 163000, Russia.
authors.forename: Vsevolod
authors.initials: V
authors.lastname: Kuzkov
authors.affiliation: Department of Cardiology and Department of Research and Education, General Hospital Celje, Oblakova 5, SI-3000 Celje, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Molnar
authors.affiliation: Medical ICU, General Hospital Celje, Oblakova 5, SI-3000 Celje, Slovenia.
authors.forename: Gorazd
authors.initials: G
authors.lastname: Voga
authors.affiliation: Medical ICU, Paris-Sud University Hospitals, Inserm UMR-S 999, Paris-Sud University, 94 270 Le Kremlin-Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
mesh_terms: D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000628:therapy; D003422:Critical Care / Q000379:methods*; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008991:Monitoring, Physiologic; D012769:Shock / Q000503:physiopathology / Q000628:therapy