As much as I am not a huge fan of bombarding septic shock patients with IV fluids, I understand there is a role for fluid resuscitation.
When our patients get better, though, it is time to get rid of these fluids.
That is what we call deresuscitation.
It is part of the 4 D’s in fluid therapy: drug, duration, dosing, and deresuscitation.
Giving too much fluids to begin with is bad, just check out the Michelin Man example in this paper.
The primary goal should be to not give too much, but it’s hard to get it just right.
This paper was recently published and explains, as the title states, “Everything you need to know about deresuscitation“.
Hat tip to the authors. Read these free papers for yourself.
They use this ROSE model.
R for resuscitation.
O for optimization.
S for stabilization.
E for evacuation.
They list various hemodynamic, pulmonary, echocardiographic triggers for fluid evacuation, some of which I personally had never heard of.
Importantly, they also discuss when to stop deresuscitation.
Obviously a hypotensive and hypoperfused patient would check off these boxes.
Resuscitation is sexy, but so is deresuscitation.
To learn more about fluid responsiveness, CLICK HERE.

Citations for Deresuscitation

Malbrain MLNG, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, Teboul JL, Rice TW, Mythen M, Monnet X. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Ann Intensive Care. 2018 May 22;8(1):66. doi: 10.1186/s13613-018-0402-x. PMID: 29789983; PMCID: PMC5964054.
Link to Article
Link to FULL FREE PDF

Malbrain MLNG, Martin G, Ostermann M. Everything you need to know about deresuscitation. Intensive Care Med. 2022 Aug 6:1–6. doi: 10.1007/s00134-022-06761-7. Epub ahead of print. PMID: 35932335; PMCID: PMC9362613.
Link to Article
Link to FULL FREE PDF

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