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Sepsis is one of the leading causes of morbidity.
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Early administration of intravenous fluid is commonly used to decrease signs and symptoms of sepsis.
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The timing, volume, and type of fluid administered to patients diagnosed with sepsis impacts patient outcomes.
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Recent studies have challenged the notion that aggressive fluid resuscitation is beneficial in the management of sepsis.
Early Administration of Intravenous Fluids in Sepsis: Pros and Cons
Section snippets
Key points
Incidence and Prevalence
Sepsis and septic shock affect millions of people globally with a mortality rate as high as 1 in 4.3, 4 Sepsis is one of the most common reasons that patients are admitted to intensive care units (ICU) and one of the most expensive conditions to treat in US hospitals.2, 7 Septic shock is also the most common form of shock found in patients admitted to ICUs.13 The increased incidence is believed to be due to the aging population and complex comorbidities.2, 7 In the United States, sepsis affects
Implications for future research
To provide a definitive answer regarding the true effect of fluid administration in the resuscitation phase of sepsis, high-level evidence from RCTs that compare fluid resuscitation with no fluid resuscitation is needed.10 The only current RCT of fluid resuscitation in sepsis is the FEAST (fluid expansion as supportive therapy) trial that included 3141 children with severe sepsis to receive fluid resuscitation with 40 mL/kg of NS or 4% albumin or no volume resuscitation.10 However, this study
Summary
Although fluid resuscitation remains the cornerstone of early and aggressive treatment of patients with severe sepsis and septic shock, fundamental questions remain regarding optimal fluid composition, volume, and rate of fluid administration in patients with sepsis.11, 12 Current research evidence regarding aggressive fluid administration beyond the resuscitation phase of shock challenges health care providers to reconsider the fluid regimen,11, 15 and consider the concomitant administration
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Defining and diagnosing sepsis
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Association of fluid resuscitation within 30 minutes of severe sepsis and septic shock recognition with reduced mortality and length of stay
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Pitfalls in the treatment of sepsis
Emerg Med Clin N Am
(2017) Early management of severe sepsis: concepts and controversies
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Fluid resuscitation in severe sepsis
Emerg Med Clin N Am
(2017) - et al.
A rational approach to fluid therapy in sepsis
Br J Anaesth
(2016) Early recognition and management of sepsis in adults: the first six hours
Am Fam Physician
(2013)
Cited by (4)
Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: A systematic review and meta-analysis with trial sequential analysis
2019, American Journal of Emergency MedicineCitation Excerpt :The different fluid types have difference effects on different diseases, populations and genders. For example, patients with sepsis may more sensitive to metabolic acidosis and may suffer more AKI or increased mortality [22,23]. The patients included in this analysis come from different sources, but with the limited studies included in this meta-analysis, we could not perform more subgroup or sensitivity analyses.
Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning
2023, Revista Brasileira de Terapia IntensivaTHERAPEUTIC REGIMENS OF ENDOTOXAEMIA IN SHEEP
2022, Bulgarian Journal of Veterinary MedicinePositive cumulative fluid balance is a risk factor of mortality in critically septic patients
2021, Critical Care and Shock
Disclosure: No conflict of interest.