Fluid balance issues in the critically ill patient.

In critically ill patients, fluid balance management is an integral part of the process of care. In patients in shock or severe sepsis, aggressive initial fluid resuscitation has been shown to improve overall prognosis. However, in critically ill patients, cumulative fluid accumulation is recognized as a potential contributing factor to increased morbidity and mortality. Randomized clinical trials are urgently required to assess the role of fluid overload in mortality and morbidity in this population. In the meantime, we should not only focus on acute fluid resuscitation but also on cumulative fluid balance as the amount and duration of fluid accumulation may influence outcomes.