For critical illness patients, special for the patients with shock, we should make fluid resuscitation therapy, and for the patients with heart failure, we should use lots of diuretics. But during our daily works, we also meet the shock patients complicated with heart failure to treatment with diuretics, and make fluid infusion to the heart failure patients. At this time, we thought whether the daily volume of fluid intake and output is very important or not? Shall we abondon these data and focus on the special hemodynamic parameter？
Thank you very much for your answers.
This is an important question. we can not neglect the role of hemodynamic parameter in treating critically ill patients but intake and out put is also very important to monitor fluid status in special situations as you mentioned for patients with heart failure and have shock and on fluid resuscitation.
Home care was previously included in healthcare centers in county councils. Today, home care is the responsibility of municipalities. Consequently, the work of district nurses from health care centers has changed, and they face a new mission and new challenges. So, Patients in home care should have a nursing charge nurse, who cooperates with the county council,initiates and participates in care planning.
I agree with Dr. Asfour in that the ongoing I/O as well as the grand total at the end of each day (24 hour) should be measured and carefully recorded. The daily weight should also be accurately measured as well and should be measured near the same time each day as well. These parameters paired with all hemodynamic data will assist clinicians to determine any changes in therapy.
Anecdotally, when treating patients in the intensive care unit, several patients demonstrated deterioration when attention to the detail of volume neutrality was neglected. Below are reference related to outcomes and fluid status. How else does one monitor a patient's fluid status without intake and output measurements?
Bouchard, J., Soroko, S. B., Chertow, G. M., Himmelfarb, J., Ikizler, T. A., Paganini, E. P., & Mehta, R. L. (2009). Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney international, 76(4), 422-427.
Border, J. R., Hassett, J. A. M. E. S., LaDuca, J. O. H. N., Seibel, R. O. G. E. R., Steinberg, S. T. E. V. E. N., Mills, B. A. R. B. A. R. A., ... & Border, D. O. N. N. A. (1987). The gut origin septic states in blunt multiple trauma (ISS= 40) in the ICU. Annals of surgery, 206(4), 427.
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