overresuscitation

Overresuscitation refers to the administration of resuscitative care in excess of what the patient requires, leading to net harm. It most often concerns fluid therapy and vasopressor or transfusion strategies during acute resuscitation or the early post-resuscitation period, where continued aggressive intervention can create edema and organ dysfunction.

Causes include protocol-driven high-volume fluid resuscitation, failure to reassess fluid status, use of large-volume transfusions, and delayed de-escalation of therapy after perfusion is achieved. Risk is higher in sepsis, trauma, and cardiac arrest settings, where dynamic assessment may be limited.

Consequences include tissue edema, pulmonary edema, abdominal compartment syndrome, impaired microcirculation, worsened gas exchange, renal dysfunction, and higher mortality in some studies. It may also prolong ICU stay and complicate rehabilitation.

Prevention and management focus on adopting goal-directed or dynamic assessment of fluid responsiveness, using vasopressors early when indicated, limiting fluids to what is needed to maintain perfusion, and preferring restrictive transfusion strategies. Monitoring cumulative fluid balance and signs of edema helps guide de-resuscitation; if overload develops, strategies may include diuresis or renal replacement therapy.

In research and guidelines, there is ongoing emphasis on avoiding fluid overload, promoting balanced crystalloid solutions, and tailoring resuscitation to individual physiology rather than fixed protocols.