Fluids in special groups

Fluids in the elderly - Marcia Mac Dougall

We are very poor at managing fluid balance in the elderly - why?

• Comorbidities
• Less reserve
• Easily overloaded
• Easily dehydrated
• Polypharmacy
• Major surgery

Progressive loss of renal function from the age of 40

Dehydration a big problem - difficulty to diagnose and often don't complain of thirst

Important to do the simple things well - but especially in the elderly

Ended with the IFAD mantra:

“The right amount of fluid, to the right patient, at the right time”

Fluids in right heart failure - Paul Elbers

All intensivists should be aware about the right heart failure

RAP cannot predict volume responsiveness

Increase following fluid administration may imply impending right heart failure

From a Guytonian perspective: septic RV dysfunction should make you very cautiously consider giving fluids

Summary:

Guess what - not too much, not too little, just the right amount

Always try and apply fluid strategy with the right heart in mind and physiology driven

Multimodal monitoring is your friend