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Review
. 2018 Dec;24(6):512-518.
doi: 10.1097/MCC.0000000000000551.

Resuscitation fluids

Jonathan D Casey  1 , Ryan M Brown, Matthew W Semler
Affiliations
Review

Resuscitation fluids

Jonathan D Casey et al. Curr Opin Crit Care. 2018 Dec.

Abstract

Purpose of review: Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients.

Recent findings: Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults. Generally, the risk of kidney injury and death appears to be greater with semisynthetic colloids compared with crystalloids, and with 0.9% sodium chloride compared with balanced crystalloids. Whether a liberal, restrictive, or hemodynamic responsiveness-guided approach to fluid dosing improves outcomes during sepsis or major surgery remains uncertain.

Summary: As evidence on fluid resuscitation evolves, a reasonable approach would be to use primarily balanced crystalloids, consider 2-3 l for initial fluid resuscitation of hypovolemic or distributive shock, and use measures of anticipated hemodynamic response to guide further fluid administration.

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Conflict of interest statement

Conflicts of interest: none

References

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    2. This study compared fluid resuscitation with vasopressors to vasopressors alone in a hyperdynamic model of ovine endotoxemia. Compared to vasopressors alone, fluid resuscitation with 0.9% sodium chloride increased the dose of vasopressors needed to maintain mean arterial pressure, increased release of atrial natriuretic peptide, and increased serum markers of endothelial glycocalyx breakdown.

    1. Woodcock TE, Woodcock TM. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012;108:384–94. - PubMed

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