Question 1

How should I account for insensible losses?

Accepted Answer

Estimates: 500 mL/day for afebrile patients, increase by 100–150 mL/day per degree Celsius above 37°C. Ventilated patients have lower insensible loss due to humidified circuits.

Question 2

What is the target cumulative fluid balance in ARDS?

Accepted Answer

A conservative fluid strategy with near-zero or mildly negative cumulative balance after resuscitation is recommended per the FACTT trial.

Question 3

Should urine output be the only measure of effective circulating volume?

Accepted Answer

No — dynamic measures such as passive leg raise, pulse pressure variation, or stroke volume variation are more direct indicators of fluid responsiveness.

Question 4

How do I adjust for fluid boluses given for procedures or contrast?

Accepted Answer

Document all boluses explicitly. 'Hidden' sources (flushes, antibiotic diluents) can account for 500–1000 mL/day and significantly affect cumulative balance.