Article

Current Infectious Disease Reports

, Volume 12, Issue 5, pp 354-360

First online:

Early Fluid Resuscitation

  • Xavier MonnetAffiliated withService de Réanimation Médicale, Hôpital de Bicêtre Email author 
  • , Jean-Louis TeboulAffiliated withService de Réanimation Médicale, Hôpital de Bicêtre

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Abstract

Solid evidence exists that fluid therapy must be started as a first-line treatment in all patients with septic shock as soon as hypotension is detected, with the goal of rapidly restoring tissue perfusion. Crystalloids or colloids can be used for initial fluid therapy, and albumin should be reserved for patients with patent or supposed hypoalbuminemia. Once fluid administration is started, its effect must be carefully monitored. In the early stages, appropriate monitoring should ensure that fluid resuscitation actually increases cardiac preload, mean arterial pressure, and tissue oxygenation. In later stages, monitoring should help to avoid fluid overload. For this purpose, the end-point of fluid therapy should not be the static values of preload indicators, but rather the disappearance of indicators of preload responsiveness. Finally, the risk of fluid overload must always be kept in mind, especially in case of lung injury.

Keywords

Fluid Fluid responsiveness Fluid resuscitation Sepsis Septic shock Preload Preload responsiveness Crystalloids Colloids Albumin Lung water Pulse pressure variation Passive leg raising End-expiratory occlusion Fluid challenge