The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension

Abstract

Our aim with this review is to provide practical advice and management support for nurses and other healthcare practitioners in managing fluid retention in adults with right heart failure (RHF) due to pulmonary arterial hypertension (PAH). Vigilant management of RHF is important for maintaining patient quality of life, as fluid overload can lead to abdominal bloating (ascites) and peripheral oedema, which also has a major impact on patients’ morbidity and mortality. Patients with RHF should be assessed regularly for signs of fluid retention. If fluid overload develops, it is important to determine whether it is caused by the progression of PAH, a side effect of PAH-specific treatment, or another drug or comorbid condition, as this affects both the prognosis and the management strategy. Right heart failure can be treated with both pharmacological and non-pharmacological interventions to reduce fluid retention; including altering fluid and salt intake, weight monitoring, and use of diuretics. All patients on diuretics should be regularly monitored for renal dysfunction and electrolyte imbalance and given advice on how to manage the side effects associated with diuretic use. Fluid retention is often assessed and treated in clinical practice by specialist nurses, who act as a key patient contact providing advice and information on symptom management. This review provides an overview of the challenges related to fluid retention, including strategies to help patients manage symptoms and side effects of treatment.

Perioperative Management of Pulmonary Hypertension. A Review

“…Optimisation of volume status can be achieved by a stepwise approach using pharmacological and non-pharmacological methods, including fluid restriction [ 71 ]. Pharmacological methods include; Firstly, continue regular diuretics with intermittent loop diuretic doses or infusion.…”

The therapeutic features of acute kidney injury in the elderly

“…Water intake during oligo-anuria, daily fluid intake, at each additional 5ºC of the environment (≥ 25ºC) and at each additional 1ºC of body temperature (≥ 37ºC), it is recommended to increase the water intake by 0.5-1 L / day. In hypertensive and oedematous patients, the water intake decreases by 0.5-1 L / day, compared to the recommended one until the normalization of blood pressure values and the disappearance of oedema [16], [17]. During the polyuria phase: fluid intake is calculated according to the same formula, it is important to ensure adequate fluid intake, thus avoiding a large number of complications.…”

“…During the polyuria phase: fluid intake is calculated according to the same formula, it is important to ensure adequate fluid intake, thus avoiding a large number of complications. Daily weighing is important in assessing water balance [16], [17]. During the phase of oligoanuria and polyuria, it is recommended to administer thermally processed products, easily digestible, without the addition of spices.…”

Beyond the World Symposium on Pulmonary Hypertension: practical management of pulmonary arterial hypertension and evolving concepts

“…Although it may have a major impact on quality of life, there is little evidence or guidelines for the management of this common manifestation of PAH. Nevertheless, a practical approach to this issue requires a high level of involvement of all caregivers 16 . Monitoring of weight gain, appropriate salt restriction, lifestyle adaptation, and administration of oral diuretics are common measures that allow a proper fluid balance.…”

“…When fluid retention builds up, more aggressive measures such as intravenous diuretics and ultrafiltration may be considered. These measures are summarized on a well-articulated flow chart, which is readily applicable in the clinic 16 …”