**5. Conclusion**

earlier, FO is associated with high morbidity and mortality [28]. After returning blood pressure or on children returning heart rate is more valuable, the primary focus is adequate oxygen delivery to the tissue, which is directly related to cardiac output, hemoglobin concentration,

Conservative fluid management is associated with increased oxygen levels, decreased ventilator usage time, and decreased hospitalization. Patients treated in the ICU room on average will get fluid overload problems. Beside direct administration of fluids through venous access, these patients also receive fluids through drug administration and nutrient feeding and thus increasing the risk of fluid overload. However, in the maintenance phase, it is important to minimize the administration of unnecessary fluids [1, 33]. When FO is identified in a patient with stable hemodynamic and vasopressor reduction, fluid reduction should be the primary

Conventional indicators, such as MAP, pulse, weight, peripheral edema, are not reliably used in patients with critical illness. MAP and pulse rate are highly fluctuative due to drug use. Indicators of fluid volume such as end-diastolic volume and intrathoracic volume may be useful but still require further study for clinical validation. Cardiac index monitoring and ejection fractions can be used to diagnose FO. In patients with mechanical ventilation, the

A study of 49 patients using Doppler crosslinks could predict better diuresis using the index compared with changes in pulse pressure and increased MAP after fluid administration. This suggests that renal hemodynamic enhancement is essential for the occurrence of urinary out-

In sepsis patient with hypotension, the renal autoregulation mechanism is damaged by microcirculation changes. In this phase, vasopressor administration is often used to keep renal perfusion adequate, and a diuretic process still exists. Research in adults who analyzed the use of noradrenaline to keep MAP between 65 and 75 mmHg showed increased renal perfusion, with increased urine output, and less likely to require RRT. Furthermore, noradrenaline administration in patients with septic shock becomes an option for optimizing renal perfusion. The target of MAP in patients with septic shock differs depending on the history of blood pressure in patients, and patients with a normal history of takanan do not

The use of loop diuretics such as furosemide to prevent fluid retention was said effective for inducing diuresis in children and adults. Low doses of diuretics (furosemide = 0.2 mg/kg/dose) may prevent the acute episode from hypovolemia. Continuous administration of furosemide infusions (0.1–0.3 mg/kgbb/day) may also be performed, and both can maintain drug concentrations in the renal tubules and prevent compensatory mechanisms of sodium reabsorption. A decrease in blood volume is also avoided to avoid hemodynamic deterioration. The use of long diuretics can cause resistance and known to use combination of loop diuretic and thiazide

absence of variation in pulse pressure may indicate the presence of FO [10].

and arterial saturation [32].

8 Current Topics in Intensive Care Medicine

put and reduces FO [34].

are also said to be effective [23].

target to avoid negative FO effects [32].

**4.4. How to monitor fluid overload in our patients?**

show significant gains for achieving MAP targets [35].

Fluid overload is an event that is often found in the intensive care room of children. This is in because the more severe the patient the more fluid administered, not only through infusion, but the provision of drugs and nutrients are also no less. Some recent research has found that fluid overload has many negative effects, particularly, in patients who have both sepsis and ARDS. In sepsis and ARDS patients, the initial fluid administration is able to increase disease survival rate but at 48, 72 and 96 h of fluid administration may result in an increase in mortality. Strength monitoring and restriction of fluid volume after resuscitation phase become an important step in order not to fall on fluid overload. Resuscitation should be subjective, and when the hemodynamic is stable, the volume of fluid should be handled either by direct reduction or by diuretics. Fluid overload generally associated with increased mortality, morbidity, duration of mechanical ventilation, length of hospitalization and the need for renal replacement therapy (RRT).
