Defining fluid removal in the intensive care unit: A national and international survey of critical care practice

Abstract

Design and objectives: To identify and compare how intensive care unit specialists in the United Kingdom and Australia and New Zealand self-reportedly define, assess and manage fluid overload in critically ill patients using a structured online questionnaire.

Results: We assessed 219 responses. Australia and New Zealand and United Kingdom intensive care unit specialists reported using clinical examination findings, bedside tools and radiological features to assess fluid status, diagnose fluid overload and initiate fluid removal in the critically ill. An elevated central venous pressure is not regarded as helpful in diagnosing fluid overload and targeting a clinician-set fluid balance is the most popular management strategy. Renal replacement therapy is used ahead of more diuretic therapy in patients who are oligo/anuric, or when diuretic therapy has not generated an adequate response.

Conclusions: This self-reported account of practice by United Kingdom and Australia and New Zealand intensivists demonstrates that fluid overload remains poorly defined with variability in both management and practice.

Keywords: Fluid overload; assessment; critical care; fluid removal; renal replacement therapy.

Figure 1.

Frequency with which respondents use clinical features to assess fluid status, diagnose fluid overload and the frequency with which methods are chosen to initiate fluid removal in the critically ill. RRT: renal replacement therapy.