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Potential Harm Related to Fluid Resuscitation in Sepsis

  • F. van HarenEmail author
  • L. Byrne
  • E. Litton
Chapter
Part of the Annual Update in Intensive Care and Emergency Medicine book series (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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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Intensive Care UnitCanberra HospitalWodenAustralia
  2. 2.Medical SchoolAustralian National UniversityCanberraAustralia
  3. 3.Intensive Care UnitFiona Stanley HospitalPerthAustralia

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