Current views on fluid therapy in the critically ill

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Authors

Eric Hodgson, Jean-Louis Teboul, Roop Kishen

Abstract/Text

Introduction

Intravenous (IV) fluids are regularly ordered as part of the ICU routine rather than thoughtfully prescribed with due consideration of the goals of administration, the pharmacokinetics and dynamics of the fluids and potential adverse consequences of fluid administration.

Methods

The authors have attempted to summarise current clinical knowledge of IV fluids based on their assessment of the available literature.

Results

The review considers the use of IV fluids for resuscitation including "hypotensive" and small volume resuscitation, assessment of fluid responsiveness, systemic effects of IV fluids and the clinical utility of crystalloid or colloid solutions for fluid resuscitation. An approach to maintenance fluid administration in the ICU concludes the review.

Conclusions

IV fluids should be carefully prescribed with consideration of the goals of therapy and recognition of potential adverse effects. The role of clear fluids, either crystalloid or colloid is becoming increasingly limited. Blood and blood products are the cornerstone of trauma resuscitation. Resuscitation from sepsis may be better achieved by circulatory manipulation with inotropes and vasopressors rather than generation of markedly positive fluid balances. 

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