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Fig. 1 | Annals of Intensive Care

Fig. 1

From: Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

Fig. 1

The R.O.S.E. concept and the 4 phases of Fluid Therapy. Adapted according to the Open Access CC BY Licence 4.0 with permission from Malbrain et al. [9]. a Graph showing the four-hit model of shock with evolution of patients’ cumulative fluid volume status over time during the five distinct phases of resuscitation: Resuscitation (R), Optimization (O), Stabilization (S), and Evacuation (E) (ROSE), followed by a possible risk of Hypoperfusion in case of too aggressive deresuscitation. On admission patients are hypovolemic, followed by normovolemia after fluid resuscitation (EAFM, early adequate fluid management), and possible fluid overload, again followed by a phase going to normovolemia with late conservative fluid management (LCFM) and late goal-directed fluid removal (LGFR) or deresuscitation. In case of hypovolemia, O2 cannot get into the tissues because of convective problems, in case of hypervolemia O2 cannot get into the tissue because of diffuse problems related to interstitial and pulmonary edema, gut edema (ileus and abdominal hypertension). b The role of fluids within the R.O.S.E. concept

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