Fluid Therapy: Double-Edged Sword during Critical Care?

Table 1

The risks of excessive fluid load.

Settings	Adverse effect	Comment
Perioperative	Hyperchloremia and dilutional acidosis	Can be reduced using anion-balanced crystalloid solutions
	Reduced rate of wound healing	Can be related to the peripheral tissue edema
	Increased risk of anastomosis leakage	Intestinal edema and decreased splanchnic perfusion
	Increased IAP	Intestinal and abdominal wall edema
	Increased risk of respiratory complications	Pulmonary and chest wall edema. Stressfully increased work of breathing
ICU	GIPS and glycocalyx injury	The decrease of subglycocalyx oncotic pressure facilitates the capillary leakage
	Increased IAP/ACS and polycompartment syndrome	Can be associated with polycompartment syndrome resulting in AKI, liver dysfunction, FRC reduction, and ileus
	Deranged oxygenation, pulmonary and chest wall edema, incidence, or increased ARDS severity	EVLWI increase. The fluid load is an independent risk factor of ARDS
	Enteropathy	Gut edema, bacterial translocation, malabsorption, and liver congestion
	Brain edema and increased ICP	Albumin is risky
	Kidney injury	Edema of kidney parenchyma with increase of and decreased GFR
	Myocardial injury	Dilatation, ANP release, and myocardium edema associated with diastolic dysfunction (relaxation) and blockade
	Increased mortality

IAP: intraabdominal pressure, ICP: intracranial pressure, ACS: abdominal compartment syndrome, GIPS: global increased permeability syndrome, ANP: atrial natriuretic peptide, ARDS: acute respiratory distress syndrome, EVLWI: extravascular lung water index, and GFR: glomerular filtration rate.