ReviewAnnals of intensive care2014
Iatrogenic salt water drowning and the hazards of a high central venous pressure.
Review in Annals of intensive care, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 67 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Carotid Doppler Ultrasound for the Measurement of Intravascular Volume Status During Lower Body Negative Pressure Simulation
Early Goal Directed Therapy Using a Physiological Holistic View. A Multicenter Study in Latin America: The ANDROMEDA-SHOCK Study
Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis.
Peripheral Perfusion Versus Lactate Targeted Fluid Resuscitation in Septic Shock: ANDROMEDA-SHOCK PHYSIOLOGY STUDY
Who cites it
67 citing papers in PubMed, 3 syntheses or guidelines pooled it, 167 citations in OpenAlex.
- Non-invasive goal-directed fluid therapy with the pleth variability index (PVI): a systematic review and meta-analysis.Journal of clinical monitoring and computing · 2025Pooled it
- Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis.Critical care (London, England) · 2020Pooled it
- Liberal Versus Restrictive Intravenous Fluid Therapy for Early Septic Shock: Rationale for a Randomized Trial.Annals of emergency medicine · 2018Pooled it
- Deresuscitation Informed by Ultrasound in Patients With Septic Shock Trial: A Pilot Randomized Controlled Study.Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2026Trial
- Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension.The New England journal of medicine · 2023Trial
- Bolus intravenous 0.9% saline leads to interstitial permeability pulmonary edema in healthy volunteers.European journal of applied physiology · 2021Trial
- Randomized Controlled Trial of Ultrasound-guided Fluid Resuscitation of Sepsis-Induced Hypoperfusion and Septic Shock.The western journal of emergency medicine · 2021Trial
- The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study.Critical care medicine · 2019Trial
- Association of active fluid de-escalation timing with clinical outcomes in patients with septic shock: a multicenter cohort study.BMC infectious diseases · 2026Article
- Early assessment of fluid tolerance (VExUS) and stroke volume (LVOT-VTI) to predict adverse outcomes in emergency department patients with suspected sepsis.Annals of intensive care · 2026Article
- Fluid management strategies in critically ill patients with ARDS: a narrative review.European journal of medical research · 2025Review
- The incidence and risk factors of gastrointestinal dysfunction during enteral nutrition in mechanically ventilated critically ill patients.Nursing open · 2024Observational
- Article
- Effects of nurse delivered thoracic ultrasound on management of adult intensive care unit patients: A prospective observational study.International journal of nursing studies advances · 2023Article
- An Overview of Recent Developments in the Management of Burn Injuries.International journal of molecular sciences · 2023Review
- Intraoperative serum lactate levels as a prognostic predictor of outcome for emergency abdominal surgery: a retrospective study.BMC surgery · 2023Observational
- Article
- Association of vasopressors with mortality in critically ill patients with COVID-19: a systematic review and meta-analysis.Anesthesiology and perioperative science · 2023Review
- Fluid management in septic patients with pulmonary hypertension, review of the literature.Frontiers in cardiovascular medicine · 2023Review
- Combining fluids and vasopressors: A magic potion?Journal of intensive medicine · 2022Review
7 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Current teaching and guidelines suggest that aggressive fluid resuscitation is the best initial approach to the patient with hemodynamic instability. The source of this wisdom is difficult to discern, however, Early Goal Directed therapy (EGDT) as championed by Rivers et al. and the Surviving Sepsis Campaign Guidelines appears to have established this as the irrefutable truth. However, over the last decade it has become clear that aggressive fluid resuscitation leading to fluid overload is associated with increased morbidity and mortality across a diverse group of patients, including patients with severe sepsis as well as elective surgical and trauma patients and those with pancreatitis. Excessive fluid administration results in increased interstitial fluid in vital organs leading to impaired renal, hepatic and cardiac function. Increased extra-vascular lung water (EVLW) is particularly lethal, leading to iatrogenic salt water drowning. EGDT and the Surviving Sepsis Campaign Guidelines recommend targeting a central venous pressure (CVP) > 8 mmHg. A CVP > 8 mmHg has been demonstrated to decrease microcirculatory flow, as well as renal blood flow and is associated with an increased risk of renal failure and death. Normal saline (0.9% salt solution) as compared to balanced electrolyte solutions is associated with a greater risk of acute kidney injury and death. This paper reviews the adverse effects of large volume resuscitation, a high CVP and the excessive use of normal saline.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.