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Comment
. 2010;14(1):101.
doi: 10.1186/cc8201. Epub 2010 Jan 19.

Fluids in septic shock: too much of a good thing?

A B Johan Groeneveld  1
Affiliations
Comment

Fluids in septic shock: too much of a good thing?

A B Johan Groeneveld. Crit Care. 2010.

Abstract

In a recent issue of Critical Care, Brandt and colleagues report the effects of a 'liberal' fluid loading protocol compared to a more 'restrictive' protocol on hemodynamics and mortality in pigs in which septic shock had been induced. It appears that the former protocol was associated with higher mortality in spite of improved hemodynamics compared to the latter. The results of the paper are discussed here in view of the scope and mechanisms of these findings. With regard to fluid resuscitation, they indicate that too much of an otherwise good thing is harmful, even if overhydration and edema formation seem to have been prevented. They also do not exclude a specific toxic effect of the larger volumes of hydroxyethyl starch in the 'liberal' strategy. The precise nature of a toxic effect remains obscure, however, but may involve the kidneys.

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References

    1. Brandt S, Regueira T, Bracht H, Porta F, Djafarzadeh S, Takala J, Gorrasi J, Borotto E, Krejci V, Hiltebrand LB, Bruegger LE, Beldi G, Wilkens L, Lepper PM, Kessler U, Jakob SM. Effect of fluid resuscitation on mortality and organ function in experimental sepsis models. Crit Care. 2009;13:R186. doi: 10.1186/cc8179. - DOI - PMC - PubMed
    1. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a metaanalysis of randomized controlled trials. Br J Anaesth. 2009;103:637–646. doi: 10.1093/bja/aep279. - DOI - PubMed
    1. Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg. 2009;96:331–341. doi: 10.1002/bjs.6552. - DOI - PubMed
    1. Stewart RM, Park PK, Hunt JP, McIntyre RC Jr, McCarthy J, Zarzabal LA, Michalek JE. National Institutes of Health/National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network. Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. J Am Coll Surg. 2009;208:725–735. doi: 10.1016/j.jamcollsurg.2009.01.026. - DOI - PubMed
    1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL. International Surviving Sepsis Campaign Guidelines Committee; American Association of Critical-Care Nurses; American College of Chest Physicians; American College of Emergency Physicians; Canadian Critical Care Society; European Society of Clinical Microbiology and Infectious Diseases; European Society of Intensive Care Medicine. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327. doi: 10.1097/01.CCM.0000298158.12101.41. - DOI - PubMed