European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3-fluid removal at de-escalation phase.

IF 21.2 1区 医学 Q1 CRITICAL CARE MEDICINE
Marlies Ostermann, Fayez Alshamsi, Antonio Artigas Raventos, Maurizio Cecconi, Carole Ichai, Christina Jones, Manu L N G Malbrain, Xavier Monnet, Marek Nalos, Zhiyong Peng, Carmen A Pfortmueller, John Prowle, Otavio Ranzani, Manu Shankar-Hari, Adrian Wong, Morten Hylander Møller, Daniel De Backer
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Abstract

Purpose: This is the third of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on fluid management in adult critically ill patients. This part addresses fluid removal in the de-escalation phase of shock management.

Methods: This guideline was formulated by an international panel of clinical experts, methodologists, and patient representatives. A literature search was conducted to identify relevant randomized controlled trials (RCTs) in adults published up to February 2025. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision.

Results: Based on data from 13 RCTs, the panel issued three conditional recommendations. The panel suggested de-escalation of fluid therapy over no de-escalation in critically ill adults after the acute phase of fluid resuscitation (low certainty evidence). They suggested protocolized fluid removal by diuretics over usual care in critically ill patients after the acute phase of fluid resuscitation (moderate certainty evidence). A conditional recommendation was issued against the routine use of ultrafiltration or extracorporeal fluid removal in critically ill adults after the acute phase of fluid resuscitation, without other indication for RRT (low certainty evidence). There was limited evidence to comment on fluid removal in specific patient cohorts.

Conclusions: This ESICM guideline provides three recommendations to inform clinicians on fluid removal during the de-escalation phase in critically ill patients with shock who no longer need fluid resuscitation.

欧洲重症监护医学学会成人危重病人液体治疗临床实践指南:第3部分:缓解期液体清除
目的:这是欧洲重症医学学会(ESICM)关于成人危重患者液体管理的临床实践指南三部分中的第三部分。这一部分涉及在休克管理的降级阶段的液体清除。方法:本指南由临床专家、方法学家和患者代表组成的国际小组制定。我们进行了文献检索,以确定截至2025年2月发表的相关成人随机对照试验(RCTs)。建议、评估、发展和评价分级(GRADE)方法用于评估证据的确定性,并从证据转向决策。结果:基于13项随机对照试验的数据,专家组提出了三项有条件的建议。该小组建议,在急性期液体复苏后,危重成人患者应降低液体治疗的剂量,而不是不降低剂量(低确定性证据)。他们建议,在液体复苏急性期后,危重患者应采用利尿剂清除液体,而不是常规护理(中度确定性证据)。有条件的建议反对在液体复苏急性期后对危重成人常规使用超滤或体外液体清除,无其他RRT指征(低确定性证据)。在特定患者队列中,对液体清除的评价证据有限。结论:本ESICM指南提供了三条建议,告知临床医生在降级阶段不再需要液体复苏的危重症休克患者的液体清除。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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