1. Introduction
critically ill, shock, ARDS, organ dysfunction, sepsis, sepsis-induced ARDS, EVLWI, volume overload
VOLUME OVERLOAD, CRITICALLY ILL, SHOCK, SEPSIS, ARDS, ACUTE RESPIRATORY DISTRESS SYNDROME, COMPLICATIONS
We compared two de-escalation strategies guided by either extravascular lung water or global end-diastolic volume-oriented algorithms in patients with sepsis and ARDS. Sixty patients with sepsis and ARDS were randomized to receive de-escalation fluid therapy, guided either by the extravascular lung water index (EVLWI, Optimization of fluid status is a fundamental challenge of critical care practice, particularly in patients with sepsis, shock, and acute respiratory distress syndrome (ARDS) [In many cases, liberal fluid therapy in the critically ill brings minimal hemodynamic benefits but can result in numerous side effects. There are two key mechanisms by which aggressive fluid therapy may be harmful to patients with sepsis. The first mechanism is related to the direct effects of excessive infusion on the cardiovascular system, worsening the shock. The second one includes the negative effects of volume overload on organ function [Taking into account these complications related to infusion therapy, the approach to fluid and vasopressor administration in cases of shock and ARDS should be individualized and based on the patient’s unique hemodynamic and clinical characteristics [We hypothesized that de-escalation fluid management using volumetric hemodynamic monitoring, based on parameters of interstitial and intravascular sectors, is safe and leads to the attenuation of organ dysfunction in patients with sepsis-induced ARDS. Thus, the aim of our study was to compare two de-escalation strategies guided by either extravascular lung water or global end-diastolic, volume-oriented algorithms in sepsis and ARDS.