Fluid Therapy: Double-Edged Sword during Critical Care?

Table 3

Four phases of hemodynamic treatment.

	Rescue	Optimization	Stabilization	Deescalation
Treatment goal	Shock reversal/Life salvage	Adequate tissue perfusion	Zero-to-negative daily fluid balance	Fluid accumulation reversal/edema resolution
Time course	Minutes	Hours	Days	Up to weeks
Hemodynamic targets	Autoregulatory thresholds of perfusion pressure	Micro/macrocirculatory blood flow parameters	Weaning of vasopressors with stable hemodynamic conditions	Return to premorbid/chronic values of pressure and flow
Treatment options	Rapid fluid boluses + vasopressors	Repeated fluid challenges + vasopressors + Inotropes	Maintenance fluids + decreasing/chronic vasoactive agents	Diuretics or other means of fluid removal