We have located open access text paper links.
JOURNAL ARTICLE
REVIEW
Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.
Annals of Intensive Care 2018 May 23
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the "four D's" of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are "When to start intravenous fluids?", "When to stop intravenous fluids?", "When to start de-resuscitation or active fluid removal?" and finally "When to stop de-resuscitation?" In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.
Full text links
Trending Papers
Management of type 2 diabetes in the new era.Hormones : International Journal of Endocrinology and Metabolism 2023 September 14
Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it.Acute and critical care. 2023 August
The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation.Journal of Intensive Care 2023 May 24
Abdominal wall closure.British Journal of Surgery 2023 September 16
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app