Fluid resuscitation in sepsis: the great 30 mL per kg hoax

Journal of Thoracic Disease
Paul E MarikFrank Van Haren

Abstract

Large volume fluid resuscitation is currently viewed as the cornerstone of the treatment of septic shock. The surviving sepsis campaign (SSC) guidelines provide a strong recommendation to rapidly administer a minimum of 30 mL/kg crystalloid solution intravenously in all patients with septic shock and those with elevated blood lactate levels. However, there is no credible evidence to support this recommendation. In fact, recent findings from experimental, observational and randomized clinical trials demonstrate improved outcomes with a more restrictive approach to fluid resuscitation. Accumulating evidence suggests that aggressive fluid resuscitation is harmful. Paradoxically, excess fluid administration may worsen shock. In this review, we critically evaluate the scientific evidence for a weight-based fluid resuscitation approach. Furthermore, the potential mechanisms and consequences of harm associated with fluid resuscitation are discussed. Finally, we recommend an individualized, conservative and physiologic guided approach to fluid resuscitation.

Citations

May 27, 2020·Journal of Anesthesia·Ahmed Hasanin, Maha Mostafa
Aug 13, 2020·Clinical and Experimental Nephrology·Daisuke Nakano
Nov 26, 2020·Microcirculation : the Official Journal of the Microcirculatory Society, Inc·Tuhin K Roy, Timothy W Secomb
Oct 16, 2020·Chest·Dipayan ChaudhuriBram Rochwerg
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