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Indications and management of mechanical fluid removal in critical illness.
Rosner, M H; Ostermann, M; Murugan, R; Prowle, J R; Ronco, C; Kellum, J A; Mythen, M G; Shaw, A D.
Affiliation
  • Rosner MH; Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA.
  • Ostermann M; 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.
  • Murugan R; The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
  • Prowle JR; Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.
  • Ronco C; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
  • Kellum JA; The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
  • Mythen MG; University College London Hospital and University College London NIHR Biomedical Research Centre, London, UK.
  • Shaw AD; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Br J Anaesth ; 113(5): 764-71, 2014 Nov.
Article in En | MEDLINE | ID: mdl-25182016
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. CONCLUSION: Mechanical fluid removal should be considered as a therapy for FO, but more research is necessary to determine its exact role and clinical application.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Critical Illness / Fluid Therapy Type of study: Etiology_studies / Guideline / Prognostic_studies / Systematic_reviews Limits: Humans Language: En Journal: Br J Anaesth Year: 2014 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Critical Illness / Fluid Therapy Type of study: Etiology_studies / Guideline / Prognostic_studies / Systematic_reviews Limits: Humans Language: En Journal: Br J Anaesth Year: 2014 Document type: Article Affiliation country: Country of publication: