THE RELATIONSHIP BETWEEN FLUID BALANCE AND FLUID MANAGEMENT STRATEGIES WITH MORTALITY AND CLINICAL OUTCOMES IN ICU: A SYSTEMATIC REVIEW

Background : Fluid balance is one of the fundamental management aspects in critically ill patients treated in the intensive care unit (ICU). Fluid resuscitation is necessary to maintain tissue perfusion and increase cardiac output. However, excessive fluid accumulation can cause adverse effects. Several studies have shown that positive cumulative fluid balance in the early stages of ICU admission can worsen outcomes in critically ill patients and is associated with high mortality. Methods : A literature search was conducted in the PubMed, ScienceDirect, and SpringeLink databases. Of the 834 articles, five systematic reviews and meta-analyses that assessed the relationship between fluid balance and fluid management strategies with mortality and clinical outcomes in ICU patients in the last five years and met the established inclusion and exclusion criteria were analyzed in this systematic review. Result : Based on the search results, five systematic reviews and meta-analyses were found that were relevant to the research objective, namely the relationship between fluid balance and fluid management strategies with mortality and clinical outcomes in ICU patients. Two observational meta-analyses reported that fluid overload and positive cumulative fluid balance in the early ICU phase were consistently associated with increased short- and long-term mortality, as well as organ complications including acute kidney injury (AKI), the need for renal replacement therapy (RRT), and worsening respiratory function. Conversely, three RCT meta-analyses showed that restrictive fluid resuscitation strategies did not significantly reduce mortality but were safe to use and provided secondary benefits in the form of reduced mechanical ventilation duration. Conclusion : Fluid overload after the resuscitation phase in the ICU is consistently associated with increased mortality and organ complications. Meanwhile, restrictive fluid strategies in clinical trials do not reduce mortality but are safe and beneficial for secondary outcomes such as mechanical ventilation duration. An individualized and phase-based fluid approach, in line with the ROSE concept, is needed to prevent fluid overload and improve outcomes in critically ill patients.