Fluid management in the critically ill

The stabilisation of critically ill patients in the intensive care unit involves the administration of IV fluids to normalise blood flow and increase cardiac output, but an excessive amount can lead to fluid overload, which increases the risk of respiratory distress and mortality.

For this reason, fluid titration constitutes an essential component of resuscitation, and the fluid management strategies applied depend on the stage of the illness.

During the rescue or salvage phase, substantial amounts of fluid must be administered to restore tissue perfusion and prevent organ failure. Subsequently, the fluid amount must be optimised based on clinical and haemodynamic parameters, as well as on the patient’s response, until fluid status is stabilised.

In the de-escalation phase, water can be removed or fluid therapy restricted.

This article addresses the current evidence, strategies, and challenges in the monitoring of fluid requirements in the context of critical care and discusses the different types of fluids available, their indications, limitations, and side effects, taking into consideration the individual patient factors and conditions.

Despite the availability of guidelines for IV fluid therapy, clear guidance for fluid titration during resuscitation is needed with the goal to improve the prognosis of acutely ill patients.