Fluid management in sepsis

The current treatment guidelines for sepsis recommend early administration of antibiotics and intravenous fluids in addition to control of the foci of infection.

However, solid evidence on the optimal type and concentration of fluid to administer is lacking.

This review focuses on the physiology of fluid resuscitation in critically ill patients with sepsis and describes the consequences of sepsis-induced intravascular volume depletion and the effects of intravenous fluid administration on cardiac output, oxygen delivery, and organ function.

It summarises mortality data from clinical trials evaluating fluid bolus administration in initial sepsis resuscitation and after initial resuscitation to optimise the patient’s haemodynamic status and improve organ perfusion, while stressing the harmful effects of excessive fluid.

The authors discuss tests to predict haemodynamic response, highlighting the better performance of dynamic variables vs. static variables despite the absence of evidence showing improvement in clinical outcomes.

The benefits and limitations of using crystalloids, colloids, and saline solutions are described, in particular the use of albumin in septic shock. The rationale for blood transfusions in patients with anemia and sepsis or septic shock is also covered.

Knowledge gaps on as optimal rates of fluid administration and procedures after initial resuscitation are noted.