The fluids debate: what about a different approach?
*Ex SIMEU president
**Dir. UOC Med.d’Urgenza e PS A.O. Rummo Benevento
The very updated editorial by Iaccarino and Bertazzoni, recently published on ITJEM, underlines once more how the long lasting fluids debate is still far from being totally resolved (1,2). So we thought if a different approach, based on a few concepts of applied physiopathology, could be of interest to the internist/intensivist, who must face the fluids manipulation in critically ill subjects. Indeed, we’d like first to recall some essentials in hemodynamics, and then refer to some clinical scenarios likely to be observed almost everyday.
Back to the basics
- CVP stable or a bit raised and ‘perfusion’ improved = give more fluids
- Raised CVP and/or wet lungs and/or same poor perfusion = stop fluids
Is my fluids choice better than yours ?
Fixed formulas in dysosmolality syndromes ?
- Iaccarino C, Bertazzoni G. Fluids and which fluids? This is the question ! ITJEM 2018 July ISSN 2532-1285
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