Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Abstract

Fluid overload has been associated with morbidity and mortality in various clinical scenarios including heart failure and critical illness. It exerts pathologic sequelae in almost all the organ systems. Proper management of patients with fluid overload requires knowledge of the underlying pathophysiology, objective evaluation of volume status, selection of appropriate therapeutic options, and maintenance and modulation of tissue perfusion. There are several methods to appraise volume status but none without limitations. In this review, we discuss the diagnostic utility, prognostic significance, and shortcomings of various bedside tools in the detection of fluid overload and evaluation of hemodynamic status. These include clinical examination, biomarkers, blood volume assessment, bioimpedance analysis, point-of-care ultrasound, and remote pulmonary pressure monitoring. In our opinion, clinicians must adopt a multiparametric approach offsetting the limitations of individual methods to formulate a management plan tailored to patients’ needs.