guideline recommendations
ACC/AHA 2005 Guideline Update
for the Diagnosis and Management of Chronic Heart Failure in the
Adult
4.4.1. Management of Fluid Status
"If the degree of
renal dysfunction is severe or if the edema becomes resistant to
treatment, ultrafiltration or hemofiltration may be needed
to achieve adequate control of fluid retention (489, 490). The use
of such mechanical methods of fluid removal can produce meaningful
clinical benefits in patients with diuretic-resistant HF and may
restore responsiveness to conventional doses of loop diuretics."
"In general, patients should not
be discharged from the hospital until a stable and effective diuretic
regimen is established, and ideally, not until euvolemia is achieved.
Patients who are sent home before these goals are reached are at
high risk of recurrence of fluid retention and early readmission
(491), because unresolved edema may itself attenuate the response
to diuretics (164-166). Once euvolemia is achieved, the patient’s
dry weight can be defined and used as a continuing target for the
adjustment of diuretic doses."
A Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines (Writing Committee
to Update the 2001 Guidelines for the Evaluation and Management
of Heart Failure). Developed in Collaboration With the American
College of Chest Physicians and the International Society for Heart
and Lung Transplantation. Endorsed by the Heart Rhythm Society
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis
GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates
JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. ACC/AHA 2005 guideline
update for the diagnosis and management of chronic heart failure
in the adult: a report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines (Writing Committee
to Update the 2001 Guidelines for the Evaluation and Management
of Heart Failure). American College of Cardiology Web Site.
|
