3. Discussion
metabolic alkalosis, shock, inflammation, lung edema, ARDS, EVLWI, AKI, sepsis, hypovolemia, acute kidney injury
METABOLIC ALKALOSIS, SHOCK, INFLAMMATION, ELECTROLYTE DISTURBANCE, LUNG EDEMA, LOW URINE OUTPUT, SEPSIS, ARDS, COMPLICATIONS
Our study has shown that the de-escalation therapy of sepsis and ARDS after initial fluid resuscitation did not compromise hemodynamics or metabolic status; moreover, it can improve arterial oxygenation and organ function.One of the important parts of our study was the evaluation of the safety of de-escalation therapy. In most investigations, active fluid removal was started only in hemodynamically stable patients [Well-known complications of furosemide infusion are metabolic alkalosis and electrolyte disturbances [The important risk factor for the development of AKI and low urine output is hypovolemia. However, many cases of AKI are considered volume unresponsive, in particular during systemic inflammation and sepsis [Our study has revealed that de-escalation fluid management was accompanied by a decrease in the SOFA scores of both groups. Mainly, it was achieved due to the attenuation of shock, ARDS, and acute kidney injury. Similar findings were obtained by other authors using a de-escalation strategy over a 5-day study period [For the moment, it is still unclear which strategy is better to follow after initial fluid resuscitation: restrictive fluid therapy or active fluid removal. Indeed, more restrictive fluid management, together with earlier administration of vasopressors, if needed, may reduce the volume of fluid therapy [Another important issue is the decision about when to start de-escalation fluid management. There is a wide spectrum of clinical criteria for such a decision, including a decrease inPaODynamic indices of fluid responsiveness, such as PPV or SVV, have better diagnostic value as compared to static variables in fully sedated and mechanically ventilated patients, although both PPV and SVV have a number of limitations, including vasopressor support, low tidal volume, and spontaneous breathing [It has been shown that GEDVI is one of the most accurate indicators of preload in patients with sepsis and ARDS, and that GEDVI-oriented fluid therapy prevents the progress of lung edema [We did not observe any intergroup difference in the 48-h fluid balance. The possible explanation of this finding is that we observed a similar pattern of changes in GEDVI and EVLWI after the fluid therapy conducted before the enrollment of 60% of our patients. This circumstance resulted in similar fluid management strategies for both groups.