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Potential Harm Related to Fluid Resuscitation in Sepsis

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Annual Update in Intensive Care and Emergency Medicine 2019

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

A liberal approach to fluid resuscitation in patients with sepsis and evidence of hypoperfusion is endorsed by international guidelines as an essential first-line intervention [1]. The use of this therapy is based in part on a long history and familiarity with fluid use in the resuscitation of other forms of shock and a “hypoperfusion centric” theory of the pathophysiology of sepsis [2]. The Surviving Sepsis Campaign recommendation for a fluid challenge given at a rate of 500–1000 mL of crystalloids or 300–500 mL of colloids over 30 min, is graded as Grade E, which means it is supported only by non-randomized historical controls, case series, uncontrolled studies and expert opinion [1]. In addition to a lack of high quality randomized controlled trials (RCTs), demonstrating benefit of standard volume fluid resuscitation for sepsis compared to a lower dose, the safety of standard doses of intravenous resuscitation has also been called into question. Data from experimental, observational and prospective randomized studies suggest improved outcomes with a restrictive approach to fluid resuscitation [2–5].

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Author information

Authors and Affiliations

  1. Intensive Care Unit, Canberra Hospital, Woden, ACT, Australia

    F. van Haren & L. Byrne

  2. Medical School, Australian National University, Canberra, ACT, Australia

    F. van Haren & L. Byrne

  3. Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia

    E. Litton

Authors
  1. F. van Haren
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  2. L. Byrne
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  3. E. Litton
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Correspondence to F. van Haren .

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Editors and Affiliations

  1. Dept. of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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van Haren, F., Byrne, L., Litton, E. (2019). Potential Harm Related to Fluid Resuscitation in Sepsis. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2019. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-06067-1_42

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  • DOI: https://doi.org/10.1007/978-3-030-06067-1_42

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  • Publisher Name: Springer, Cham

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