Physiologic approach to diuresis in de-resuscitation phase in intensive care

Lal et al. comments on combination diuretic therapy and electrolyte disturbances are pertinent, but it is prudent to understand that our protocol is intended for the broad intensive care unit population, not only those presenting with acute decompensated heart failure. Predominate evidence for utilization of hypertonic saline (HTS) as a diuretic adjunct is restricted to patients presenting with heart failure, and current evidence would advise against such in the general critically ill population given that chloride is directly, rather than inversely, associated with mortality while the correlation with sodium may be biphasic [6, 7]. [...]data are available, HTS remains unlikely a feasible addition to broad protocolized approaches at this time. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al.