Critical Matters Fluid Overload in the ICU
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Oct 9, 2025 Joining Dr. Sergio Zanotti is Dr. Michael J. Connor, Jr., a revered figure in Critical Care Medicine and Nephrology at Emory University. They dive deep into the critical issue of fluid overload in the ICU, discussing its impact on patient survival and organ recovery. Dr. Connor explains how fluid overload arises, its detrimental effects on kidneys, and strategies for effective management, including the phased approach to fluid management. He emphasizes the importance of objective measurement and the judicious use of diuretics, while reflecting on valuable lessons learned throughout his career.
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Fluid Overload Slows Recovery
- Fluid overload commonly occurs after necessary resuscitation and slows organ recovery.
- Resolving overload and returning patients to euvolemia improves organ function and survival.
Hidden Fluid Creep Is Major Source
- Most ICU patients gain excess fluid from resuscitation and hidden "fluid creep."
- Hidden carrier fluids, medications, and flushes often exceed bolus resuscitation volumes.
Overload Predicts Worse Outcomes
- Fluid overload strongly associates with—and likely causes—worse outcomes and higher mortality.
- Severity scores don't reliably predict how much fluid a patient will accumulate.
