Preload responsiveness-guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical-physiological study

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dc.contributor.authorCastro, Ricardo
dc.contributor.authorBorn, Pablo
dc.contributor.authorRoessler, Eric
dc.contributor.authorLabra, Christian
dc.contributor.authorMcNab, Paul
dc.contributor.authorBravo, Sebastian
dc.contributor.authorSoto, Dagoberto
dc.contributor.authorKattan, Eduardo
dc.contributor.authorHernandez, Glenn
dc.contributor.authorBakker, Jan
dc.date.accessioned2025-01-20T16:09:38Z
dc.date.available2025-01-20T16:09:38Z
dc.date.issued2024
dc.description.abstractThis study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach. Twelve patients were placed in each group (n = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, p = 0.031) and extubation (26 h vs. 57 h, p = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, p = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group. FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.
dc.description.funderAgencia Nacional de Investigacion y Desarrollo (ANID) , Chile
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.jcrc.2024.154901
dc.identifier.eissn1557-8615
dc.identifier.issn0883-9441
dc.identifier.urihttps://doi.org/10.1016/j.jcrc.2024.154901
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90163
dc.identifier.wosidWOS:001303137000001
dc.language.isoen
dc.revistaJournal of critical care
dc.rightsacceso restringido
dc.subjectFluid overload
dc.subjectFluid balance
dc.subjectPassive leg raising
dc.subjectSpontaneous breathing trial
dc.subjectWeaning
dc.subjectFluid responsiveness
dc.subjectPreload responsiveness
dc.subjectFluid removal
dc.subjectDepletive therapy
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titlePreload responsiveness-guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical-physiological study
dc.typeartículo
dc.volumen84
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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