DOI: 10.1097/CCM.0b013e3182653529

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PMID: 23080468

Issn Print: 0090-3493

Publication Date: 2012/11/01


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The association between intravascular fluid balance and patient outcomes in the intensive care unit

Jesse M. Raiten; Jacob T. Gutsche

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Excerpt

We read with great interest the study by the RENAL Replacement Therapy Study Investigators (1), which found that a negative mean daily fluid balance was associated with improved clinical outcomes. Although the study makes a compelling case to avoid a positive fluid balance in many patients in the intensive care unit, we are disappointed that no data was provided regarding intravascular volume status. While the authors note that edema was present in approximately 44% of patients, edema is not always reflective of intravascular volume status, particularly in intensive care unit patients.
Traditional teaching has held that achieving a negative fluid balance in the presence of acute renal failure is safe as long as intravascular volume status is adequate, whereas diuresing a patient with an inadequate preload may worsen renal function. It would be interesting to know if the relationship between a negative fluid balance and improved outcomes remained true in the presence of gross volume overload but intravascular hypovolemia, a common clinical scenario in the intensive care unit patient population.
The authors have not disclosed any potential conflicts of interest.
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