Fluid management strategies and their interaction with mechanical ventilation: from experimental studies to clinical practice

Abstract Patients on mechanical ventilation may receive intravenous fluids via restrictive or liberal fluid management. A clear and objective differentiation between restrictive and liberal fluid management strategies is lacking in the literature. The liberal approach has been described as involving fluid rates ranging from 1.2 to 12 times higher than the restrictive approach. A restrictive fluid management may lead to hypoperfusion and distal organ damage, and a liberal fluid strategy may result in endothelial shear stress and glycocalyx damage, cardiovascular complications, lung edema, and distal organ dysfunction. The association between fluid and mechanical ventilation strategies and how they interact toward ventilator-induced lung injury (VILI) could potentiate the damage. For instance, the combination of a liberal fluids and pressure-support ventilation, but not pressure control ventilation, may lead to further lung damage in experimental models of acute lung injury. Moreover, under liberal fluid management, the application of high positive end-expiratory pressure (PEEP) or an abrupt decrease in PEEP yielded higher endothelial cell damage in the lungs. Nevertheless, the translational aspects of these findings are scarce. The aim of this narrative review is to provide better understanding of the interaction between different fluid and ventilation strategies and how these interactions may affect lung and distal organs. The weaning phase of mechanical ventilation and the deresuscitation phase are not explored in this review..

Take-home message Ventilatory management may be affected by restrictive and liberal fluid strategies due to physiological interaction between heart–lung, possibly yielding to distal organ damage in critical ill patients. Pre-clinical studies evaluated the effects of different fluid strategies on ventilator-induced lung injury during assisted ventilation, at different PEEP levels, as well as after an abrupt decrease in PEEP..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:11

Enthalten in:

Intensive Care Medicine Experimental - 11(2023), 1 vom: 21. Juli

Sprache:

Englisch

Beteiligte Personen:

de Carvalho, Eduardo Butturini [VerfasserIn]
Battaglini, Denise [VerfasserIn]
Robba, Chiara [VerfasserIn]
Malbrain, Manu L. N. G. [VerfasserIn]
Pelosi, Paolo [VerfasserIn]
Rocco, Patricia Rieken Macedo [VerfasserIn]
Silva, Pedro Leme [VerfasserIn]

Links:

Volltext [kostenfrei]

Themen:

Acute respiratory distress syndrome
Fluid management
Hemodynamics
Liberal fluids
Mechanical ventilation
Restrictive fluids

Anmerkungen:

© The Author(s) 2023

doi:

10.1186/s40635-023-00526-2

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2144591318

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