What is the role of fluid resuscitation in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Hypovolemia is an important factor contributing to shock and tissue hypoxia; therefore, all patients with sepsis require supplemental fluids. The amount and rate of infusion are guided by an assessment of the patient’s volume and cardiovascular status.

Monitor patients for signs of volume overload, such as dyspnea, elevated jugular venous pressure, crackles on auscultation, and pulmonary edema on the chest radiograph. Improvements in mental status, heart rate, MAP, capillary refill, and UOP indicate adequate volume resuscitation.

Volume resuscitation can be achieved with either crystalloid or colloid solutions. The crystalloid solutions are 0.9% sodium chloride and lactated Ringer solution; the colloid solutions are albumin, dextrans, and pentastarch. Although most clinical trials have not shown either type of resuscitation fluid to be superior in septic shock, a meta-analysis by Delaney et al found a significant reduction in mortality associated with albumin-containing solutions as compared with other fluid resuscitation regimens. [83]

It should be kept in mind, however, that crystalloid fluids not only must be given in considerably (2-4 times) greater volumes than colloid fluids but also take longer to achieve the same end points. On the other hand, colloid solutions are much more expensive than crystalloid solutions.


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