TABLE 2.
Complications of fluid overload
| Central nervous system | Cerebral oedema ↑ |
| Altered consciousness, stupor, coma Impaired cognition | |
| Delirium | |
| Intracranial hypertension (ICP ↑) | |
| Intracranial compartment syndrome | |
| Decreased cerebral perfusion pressure | |
| (CPP ↓ = MAP – ICP) | |
| Increased intraocular and intra-orbital | |
| pressure (IOP ↑) | |
| Intra-orbital compartment syndrome | |
| Cardiovascular system | Myocardial oedema ↑ |
| Conduction disturbance Impairment in cardiac contractility | |
| Diastolic dysfunction | |
| Increased central venous pressure | |
| (CVP ↑ and PAOP ↑) | |
| Decreased venous return | |
| Decreased stroke volume and cardiac | |
| output | |
| Decrease in (global) ejection fraction | |
| Cardio abdominal renal syndrome (CARS) | |
| Myocardial depression | |
| Pericardial effusion ↑ | |
| Increased global end diastolic volume | |
| (GEDVI ↑) | |
| Increased right ventricular end diastolic | |
| volume (RVEDVI ↑) | |
| Respiratory system | Diffusion abnormalities Pulmonary oedema ↑ Pleural effusion ↑ |
| Altered pulmonary and chest wall | |
| elastance (cfr IAP ↑) | |
| PaO2 ↓ PaCO2 ↑ PaO2/FiO2 ↓ | |
| Extra vascular lung water (EVLWI) ↑ | |
| Pulmonary vascular permeability index ↑ | |
| Lung volumes ↓ (cfr IAP ↑) | |
| Prolonged ventilation ↑ | |
| Difficult weaning ↑ | |
| Work of breathing↑ | |
| Gastrointestinal system | Ascites formation ↑ Gut oedema ↑ Malabsorption ↑ |
| Ileus ↑ | |
| Bowel contractility ↓ | |
| IAP ↑ and APP (= MAP – IAP) ↓ | |
| Abdominal compartment syndrome | |
| Success enteral feeding ↓ | |
| Intestinal permeability ↑ | |
| Bacterial translocation ↑ | |
| Splanchnic microcirculatory flow ↓ | |
| Decreased indocyanine green plasma | |
| disappearance rate (ICG-PDR ↓) | |
| Decreased gastric intramucosal pH (pHi ↓) | |
| Hepatic system | Hepatic congestion ↑ |
| Impaired synthetic function Cholestasis ↑ | |
| Cytochrome P450 activity ↓ | |
| Hepatic compartment syndrome | |
| Lactate clearance ↓ | |
| Renal system | Renal interstitial oedema ↑ Renal venous pressure ↑ Renal blood flow ↓ Renal interstitial pressure ↑ Renal resistive index ↑ Salt + water retention↑ Creatinine + uraemia ↑Glomerular filtration rate (GFR) ↓ Renal vascular resistance ↑ Renal compartment syndrome |
| Peripheral | Tissue oedema ↑ Poor wound healing ↑ Wound infection ↑ Pressure ulcers ↑ Abdominal wall compliance ↓ |
| Metabolic | Endocrine disturbances Renin angiotensin aldosterone disturbance Altered glucose metabolism CIRCI |
CARS – cardio-abdominal renal syndrome, CIRCI – critical illness-related corticosteroid insufficiency, CPP – cerebral perfusion pressure, CVP – central venous pressure, EVLWI – extravascular lung water index, GEDVI – global end diastolic volume index, GFR – glomerular filtration rate, IAP – intra-abdominal pressure, ICG-PDR – indocyanine green plasma disappearance rate, ICP – intracranial pressure, IOP – intra-ocular pressure, MAP – mean arterial pressure, PaCO2 – partial pressure of carbon dioxide, PaO2 – partial pressure of oxygen, PaO2/FiO2 – oxygen arterial pressure/inspired fraction of oxygen, PAOP – pulmonary artery occlusion pressure, pHi – power of hydrogen, RVEDVI – right ventricular end diastolic volume.