Using a diuresis protocol for volume de-resuscitation, we demonstrated a significant decrease in net cumulative fluid balance at 72 h following shock resolution, with potential benefit on clinical outcomes including renal recovery, mortality, and ICU length of stay.

Although this study supports the implementation of a diuresis protocol in the ICU, larger randomized controlled trials are needed to confirm or refute the potential benefits of de-resuscitation, through protocol-driven diuresis, on important patient centered outcomes, such as ICU length of stay, ventilator-free days, and in-hospital mortality, as suggested by observed associations in the present study.

A total of 364 patients were included, 91 in the protocol group and 273 receiving standard care.

Protocolized diuresis was associated with a significant decrease in 72-h post-shock cumulative fluid balance.

In-hospital mortality in the intervention group was lower compared to the historical group and higher ICU-free days.

This was a pre-post single-center pilot study within the medical intensive care unit (ICU) of a large academic medical center.

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