Every mirror has two faces, so the treatment arm has to be balance with the harm or side effects as well. When we administer our patients the fluid therapy, it is true that when we are facing with the low blood pressure, we would start with fluid management or resuscitation at the very first step. However, sometimes or many times that we are endangering our patients loading them too much fluid, because it is simply as they are not the ones who are responsive to the treatment.
I can recall my experience working at the Surgical ICU, there was a granddad with a history of postoperative bilateral nephrectomy, therefore, he was totally dependent on his regular haemodialysis since he did not have his kidneys any more. We treated him, dried him, when he was presented to us because of the acute heart failure just within 48 hours of his discharge from our unit, there was a call to bounce him back because an episode of hypotension and the first think the uro residents did was fluid loading.
Fluid input requires the way out as well or Fluid output, when your patient has impair cardiovascular tree, the kidney failure will soon follow. Fluid also moves to where it does not belong, for example the lungs, it would cause impair oxygenation and increase work of breathing, when it moves to skin or muscle it would be very easy to detect because you are increasing your patient's body weight and making tissue oedema. When this bad things happen, it would increase the days your patient would need to stay in the ICU or in the hospital, increasing the risks of infection and ventilator support.
You may require more monitoring technique to differentiate whether or not you should load your patient with fluid therapy, if it is the case that your patient does not deserve it, you don't have to do so.
A recent report about the harm of too much fluid for critically ill neurologic/neurosurgical patients on SCCM page can be accessed here.
I can recall my experience working at the Surgical ICU, there was a granddad with a history of postoperative bilateral nephrectomy, therefore, he was totally dependent on his regular haemodialysis since he did not have his kidneys any more. We treated him, dried him, when he was presented to us because of the acute heart failure just within 48 hours of his discharge from our unit, there was a call to bounce him back because an episode of hypotension and the first think the uro residents did was fluid loading.
Fluid input requires the way out as well or Fluid output, when your patient has impair cardiovascular tree, the kidney failure will soon follow. Fluid also moves to where it does not belong, for example the lungs, it would cause impair oxygenation and increase work of breathing, when it moves to skin or muscle it would be very easy to detect because you are increasing your patient's body weight and making tissue oedema. When this bad things happen, it would increase the days your patient would need to stay in the ICU or in the hospital, increasing the risks of infection and ventilator support.
You may require more monitoring technique to differentiate whether or not you should load your patient with fluid therapy, if it is the case that your patient does not deserve it, you don't have to do so.
A recent report about the harm of too much fluid for critically ill neurologic/neurosurgical patients on SCCM page can be accessed here.
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