A narrative review of pharmacologic de-resuscitation in the critically ill

Brittany D. Bissell, J. Chris Donaldson, Peter E. Morris, Javier A. Neyra

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


Despite evidence highlighting harms of fluid overload, minimal guidance exists on counteraction via utilization of diuretics in the de-resuscitation phase. While diuretics have been shown to decrease net volume and improve clinical outcomes in the critically ill, a lack of standardization surrounding selection of diuretic regimen or monitoring of de-resuscitation exists. Current monitoring parameters of de-resuscitation often rely on clinical signs of fluid overload, end organ recovery and other biochemical surrogate markers which are often deemed unreliable. The majority of evidence suggests that achieving a net-negative fluid balance within 72 h after shock resolution may be of benefit; however, approaches to such goal are uncertain. Loop diuretics are a widely available type of diuretic for removal of volume in patients with sufficient kidney function, with the potential for adjunct diuretics in special circumstances. At present, administration of diuretics within the broad critically ill population fails to find uniformity and often efficacy. Given the lack of randomized controlled trials in this susceptible population, we aim to provide a thorough therapeutic understanding of diuretic pharmacotherapy which is necessary in order to achieve desired goal of fluid balance and improve overall outcomes.

Original languageEnglish
Pages (from-to)156-162
Number of pages7
JournalJournal of Critical Care
StatePublished - Oct 2020

Bibliographical note

Publisher Copyright:
© 2020 Elsevier Inc.


  • Critical care
  • Diuresis
  • Volume overload
  • de-resuscitation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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