+Model
MEDIN-1603; No. of Pages 11 ARTICLE IN PRESS
Med Intensiva. 2020;xxx(xx):xxx---xxx
http://www.medintensiva.org/
REVIEW
Ten answers to key questions for fluid management in
intensive care
F. Sanfilippo a,∗ , A. Messina b,c , M. Cecconi b,c , M. Astuto a,d,e
a
Department of Anaesthesia and Intensive Care, A.O.U. ‘‘Policlinico-Vittorio Emanuele’’, Catania, Italy
b
Humanitas Clinical and Research Center --- IRCCS, Milano, Italy
c
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
d
School of Anaesthesia and Intensive Care, University Hospital ‘‘G. Rodolico’’, University of Catania, Catania, Italy
e
Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of
Catania, Catania, Italy
Received 27 July 2020; accepted 17 October 2020
KEYWORDS Abstract This review focuses on fluid management of critically ill patients. The topic is
Sepsis; addressed based on 10 single questions with simplified answers that provide clinicians with
Septic shock; the basic information needed at the point of care in treating patients in the Intensive Care
Hemodynamic Unit. The review has didactic purposes and may serve both as an update on fluid management
monitoring; and as an introduction to the subject for novices in critical care.
Echocardiography; There is an urgent need to increase awareness regarding the potential risks associated with
Crystalloids; fluid overload. Clinicians should be mindful not only of the indications for administering fluid
Colloids loads and of the type of fluids administered, but also of the importance to set safety limits.
Lastly, it is important to implement proactive strategies seeking to establish negative fluid
balance as soon as the clinical conditions are considered to be stable and the risk of deterioration
is low.
© 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
PALABRAS CLAVE Diez respuestas a preguntas clave para el manejo de fluidos en cuidados intensivos
Sepsis;
Shock séptico; Resumen Esta revisión se centra en el manejo de fluidos en el paciente crítico. Discutimos
Monitoreo el tema con un enfoque basado en 10 preguntas individuales con respuestas simplificadas, que
hemodinámico; ofrecen al personal clínico la información básica necesaria, a pie de cama, para tratar a los
Ecocardiografía; pacientes en las unidades de cuidados intensivos. Esta revisión tiene propósitos didácticos y
Cristaloides; puede servir tanto como actualización sobre el manejo de fluidos como una introducción al
Coloides tema para los que comienzan a tratar a pacientes críticos.
∗ Corresponding author.
E-mail address: (F. Sanfilippo).
https://doi.org/10.1016/j.medin.2020.10.005
0210-5691/© 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Please cite this article in press as: Sanfilippo F, et al. Ten answers to key questions for fluid management in intensive
care. Med Intensiva. 2020. https://doi.org/10.1016/j.medin.2020.10.005
, Maecenas sodales semper euismod. Nam non suscipit enim. Donec id lorem at est suscipit posuere. Etiam tincidunt nisi eget
leo faucibus porta. Sed congue magna in dignissim tristique. Morbi sodales, enim quis scelerisque congue, risus nisi venenatis
dolor, ut finibus magna augue vel elit. Integer nec mauris nec ligula elementum dictum. Nullam semper luctus justo, eget
tincidunt metus eleifend id. Nunc semper non leo et eleifend
Etiam dapibus tincidunt pulvinar. Cras lorem felis, mattis sodales congue sed, semper eu lorem. Lorem ipsum dolor sit amet,
consectetur adipiscing elit. Proin faucibus est dictum, pulvinar dui vitae, elementum leo. Maecenas elementum consequat nisl
ut feugiat. Morbi dignissim ex vitae malesuada imperdiet. In blandit, arcu at finibus egestas, neque nisi egestas diam, et
fringilla orci est ut ligula. Pellentesque habitant morbi tristique senectus et
Morbi ac scelerisque magna. Integer imperdiet ligula sit amet est vestibulum dapibus. Sed facilisis et tellus sed dictum.
Quisque non maximus augue. Etiam euismod semper diam, interdum ultrices velit. Vivamus nulla enim, convallis vel leo sit
amet, efficitur maximus est. Nullam eu lacinia metus, a hendrerit mauris. Sed eu pulvinar lorem. Sed augue leo, facilisis at eros
quis, convallis sagittis ex. Donec ut tempor lectus, eu cursus est. Vivamus
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut vulputate augue eget odio placerat, in consectetur orci tincidunt. In
hac habitasse platea dictumst. Aliquam efficitur metus ligula, sit amet vehicula ligula rutrum ut. Duis mollis nibh fringilla
lacus maximus, vitae lobortis metus volutpat. Suspendisse ut sapien erat. Pellentesque commodo nulla vitae facilisis dignissim.
Vivamus at orci mi. Donec tristique rhoncus elit ac dapibus.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Aliquam tempor aliquet risus, nec auctor ante ultrices vel. Nam rutrum
justo quis magna ornare, non lobortis purus faucibus. In hac habitasse platea dictumst. Vivamus imperdiet est vel massa
fringilla fringilla. Curabitur eros nulla, ornare quis sollicitudin ac, accumsan in tellus. Mauris tempus efficitur mi et scelerisque.
Duis diam arcu, facilisis vel eleifend vitae, congue eu nulla
Medicina intensiva, Corrected proof. doi:10.1016/j.medin.2020.10.005
MEDIN-1603; No. of Pages 11 ARTICLE IN PRESS
Med Intensiva. 2020;xxx(xx):xxx---xxx
http://www.medintensiva.org/
REVIEW
Ten answers to key questions for fluid management in
intensive care
F. Sanfilippo a,∗ , A. Messina b,c , M. Cecconi b,c , M. Astuto a,d,e
a
Department of Anaesthesia and Intensive Care, A.O.U. ‘‘Policlinico-Vittorio Emanuele’’, Catania, Italy
b
Humanitas Clinical and Research Center --- IRCCS, Milano, Italy
c
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
d
School of Anaesthesia and Intensive Care, University Hospital ‘‘G. Rodolico’’, University of Catania, Catania, Italy
e
Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of
Catania, Catania, Italy
Received 27 July 2020; accepted 17 October 2020
KEYWORDS Abstract This review focuses on fluid management of critically ill patients. The topic is
Sepsis; addressed based on 10 single questions with simplified answers that provide clinicians with
Septic shock; the basic information needed at the point of care in treating patients in the Intensive Care
Hemodynamic Unit. The review has didactic purposes and may serve both as an update on fluid management
monitoring; and as an introduction to the subject for novices in critical care.
Echocardiography; There is an urgent need to increase awareness regarding the potential risks associated with
Crystalloids; fluid overload. Clinicians should be mindful not only of the indications for administering fluid
Colloids loads and of the type of fluids administered, but also of the importance to set safety limits.
Lastly, it is important to implement proactive strategies seeking to establish negative fluid
balance as soon as the clinical conditions are considered to be stable and the risk of deterioration
is low.
© 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
PALABRAS CLAVE Diez respuestas a preguntas clave para el manejo de fluidos en cuidados intensivos
Sepsis;
Shock séptico; Resumen Esta revisión se centra en el manejo de fluidos en el paciente crítico. Discutimos
Monitoreo el tema con un enfoque basado en 10 preguntas individuales con respuestas simplificadas, que
hemodinámico; ofrecen al personal clínico la información básica necesaria, a pie de cama, para tratar a los
Ecocardiografía; pacientes en las unidades de cuidados intensivos. Esta revisión tiene propósitos didácticos y
Cristaloides; puede servir tanto como actualización sobre el manejo de fluidos como una introducción al
Coloides tema para los que comienzan a tratar a pacientes críticos.
∗ Corresponding author.
E-mail address: (F. Sanfilippo).
https://doi.org/10.1016/j.medin.2020.10.005
0210-5691/© 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Please cite this article in press as: Sanfilippo F, et al. Ten answers to key questions for fluid management in intensive
care. Med Intensiva. 2020. https://doi.org/10.1016/j.medin.2020.10.005
, Maecenas sodales semper euismod. Nam non suscipit enim. Donec id lorem at est suscipit posuere. Etiam tincidunt nisi eget
leo faucibus porta. Sed congue magna in dignissim tristique. Morbi sodales, enim quis scelerisque congue, risus nisi venenatis
dolor, ut finibus magna augue vel elit. Integer nec mauris nec ligula elementum dictum. Nullam semper luctus justo, eget
tincidunt metus eleifend id. Nunc semper non leo et eleifend
Etiam dapibus tincidunt pulvinar. Cras lorem felis, mattis sodales congue sed, semper eu lorem. Lorem ipsum dolor sit amet,
consectetur adipiscing elit. Proin faucibus est dictum, pulvinar dui vitae, elementum leo. Maecenas elementum consequat nisl
ut feugiat. Morbi dignissim ex vitae malesuada imperdiet. In blandit, arcu at finibus egestas, neque nisi egestas diam, et
fringilla orci est ut ligula. Pellentesque habitant morbi tristique senectus et
Morbi ac scelerisque magna. Integer imperdiet ligula sit amet est vestibulum dapibus. Sed facilisis et tellus sed dictum.
Quisque non maximus augue. Etiam euismod semper diam, interdum ultrices velit. Vivamus nulla enim, convallis vel leo sit
amet, efficitur maximus est. Nullam eu lacinia metus, a hendrerit mauris. Sed eu pulvinar lorem. Sed augue leo, facilisis at eros
quis, convallis sagittis ex. Donec ut tempor lectus, eu cursus est. Vivamus
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut vulputate augue eget odio placerat, in consectetur orci tincidunt. In
hac habitasse platea dictumst. Aliquam efficitur metus ligula, sit amet vehicula ligula rutrum ut. Duis mollis nibh fringilla
lacus maximus, vitae lobortis metus volutpat. Suspendisse ut sapien erat. Pellentesque commodo nulla vitae facilisis dignissim.
Vivamus at orci mi. Donec tristique rhoncus elit ac dapibus.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Aliquam tempor aliquet risus, nec auctor ante ultrices vel. Nam rutrum
justo quis magna ornare, non lobortis purus faucibus. In hac habitasse platea dictumst. Vivamus imperdiet est vel massa
fringilla fringilla. Curabitur eros nulla, ornare quis sollicitudin ac, accumsan in tellus. Mauris tempus efficitur mi et scelerisque.
Duis diam arcu, facilisis vel eleifend vitae, congue eu nulla
Medicina intensiva, Corrected proof. doi:10.1016/j.medin.2020.10.005
