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Review
. 2023 Jun 30;38(7):1603-1612.
doi: 10.1093/ndt/gfac279.

Fluids in the ICU: which is the right one?

Timo Mayerhöfer  1 , Andrew D Shaw  2 , Christian J Wiedermann  3   4 , Michael Joannidis  1
Affiliations
Review

Fluids in the ICU: which is the right one?

Timo Mayerhöfer et al. Nephrol Dial Transplant. .

Abstract

The administration of fluids is one of the most common interventions in the intensive care unit. The effects and side effects of intravenous fluids depend on the amount administered and their specific composition. Intravenous fluid solutions are either considered crystalloids (for example 0.9% saline, lactated Ringer's solution) or colloids (artificial colloids such as gelatins, and albumin). This narrative review summarizes the physiological principles of fluid therapy and reviews the most important studies on crystalloids, artificial colloids and albumin in the context of critically ill patients.

Keywords: albumin; colloids; critically ill; crystalloids, intravenous fluids.

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Conflict of interest statement

T.M. declares no competing interests. A.D.S. is a consultant for Edwards Lifesciences, FAST BioMedical, Fresenius, Astellas and AM Pharma. C.J.W. is a consultant for CSL Behring and has received fees for speaking from CSL Behring and Biotest. M.J. has received honoraria and/or research support from Baxter Healthcare Corp., AM-Pharma, CLS Behring, Fresenius, Gilead and Novartis.

Figures

Figure 1:
Figure 1:
The Frank–Starling Mechanism. Reduced fluid responsiveness may occur either due to reduced contractility during heart failure or because the plateau of the Starling curve is reached.
Figure 2:
Figure 2:
Schematic illustration of patterns of fluid response in different disease states; the red curve shows a faster decline of the effect of repeated fluid boluses (e.g. during sepsis due to increased vascular permeability). This leads to an earlier requirement of fluid boluses and consequently carries the risk of fluid overload.
Figure 3:
Figure 3:
Albumin metabolism from Joannidis et al. Ten myths about albumin. Intensive Care Med 2022 [51].
Figure 4:
Figure 4:
Main considerations for fluid resuscitation in hypovolemic critically ill patients.
See this image and copyright information in PMC

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