Advances in resuscitation and deresuscitation

Abstract

Purpose of review: This review aims to provide a perspective on fluid resuscitation strategies and emerging trends in deresuscitation, with a particular emphasis on fluid stewardship, monitoring, and personalized fluid management.

Recent findings: Recent studies underscore a paradigm shift in resuscitation strategies. Notably, aggressive plasma volume expansion has been linked to higher morbidity and mortality, favoring conservative fluid resuscitation. Dynamic parameters, such as pulse pressure variation (PPV) and stroke volume variation (SVV) outperform static markers like central venous pressure (CVP) in predicting preload responsiveness. Advances in hemodynamic monitoring and automated closed-loop fluid administration demonstrate efficacy in optimizing resuscitation. Fluid stewardship, supported by machine learning, is reshaping deresuscitation practices, and promoting negative fluid balance to reduce complications. Moreover, next-generation closed-loop systems and fluid management personalization as part of precision medicine are emerging as future directions.

Summary: Advances in fluid resuscitation challenge traditional practices, with evidence favoring personalized and goal-directed strategies. Technological innovations in hemodynamic monitoring, automated fluid control, and machine learning are driving precision fluid management. Fluid stewardship and deresuscitation aim to mitigate fluid accumulation syndrome and improve patient outcomes.

Keywords: balanced crystalloids; deresuscitation techniques; goal-directed fluid therapy; hemodynamic monitoring; resuscitation strategies.

Box 1

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FIGURE 1

The R(esuscitation) O(ptimization) S(tabilization) E(vacuation) concept.