Fluid Management in Septic Shock: a Review of Physiology, Goal-Directed Therapy, Fluid Dose, and Selection
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Purpose of Review
To review our current understanding of the intravascular space, therapeutic goals of fluid resuscitation, suitable endpoints of resuscitation, and appropriate choice of fluids.
An evolving understanding of the endothelium and glycocalyx has improved our understanding of the intravascular space. More aggressive fluid resuscitation after adoption of the Surviving Sepsis Campaign guidelines has led to an initial reduction in mortality associated with sepsis; however, the untoward effects of volume overload are increasingly evident. Fluid responsiveness is likely the best endpoint for resuscitation. Albumin has not been shown to be superior to crystalloids in the resuscitation of septic patients. As 0.9% saline has been associated with acute kidney injury, balanced buffered salt solutions are considered the preferred resuscitation fluid of choice.
Fluid resuscitation with buffered crystalloid solutions is preferred and should likely continue if the patient remains fluid responsive. This strategy risks volume overload.
KeywordsSepsis Septic shock Resuscitation Intravenous fluids Goal-directed therapy Crystalloids Colloids
Conception and design: CSJ; structured literature review and interpretation: MWB and CSJ; drafting the manuscript for important intellectual content: MWB; revising the manuscript for important intellectual content and approval of the final version to be published: CSJ.
Compliance with Ethical Standards
Conflict of Interest
Michael W. Best and Craig S. Jabaley declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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