Everything you need to know about deresuscitation

While fluid administration is one of the most common therapeutic interventions in critical care, it carries high potential for harm as overzealous fluid resuscitation may lead to glycocalix degradation and endothelial injury. Fluids should be regarded as drugs with specific indications, contraindications, and potential adverse effects. The renewed concept of “fluid stewardship” [1], analogous to antibiotic stewardship, focusses on the 4 D’s (drug, dose, duration, and de-escalation), the 4 questions (when to start and when to stop fluid therapy, and when to start and when to stop fluid removal), the 4 indications (resuscitation, maintenance, replacement and nutrition), and the conceptual ROSE model describing 4 fluid phases (resuscitation, optimization, stabilization and evacuation,