Fluid resuscitation in sepsis: the great 30 mL per kg hoax

Date

2020

Authors

Marik, Paul E.
Byrne, Liam
Van Haren, Frank

Journal Title

Journal ISSN

Volume Title

Publisher

Pioneer Bioscience Publishing Company (PBPC)

Abstract

Large volume fluid resuscitation is currently viewed as the cornerstone of the treatment of septic shock. The surviving sepsis campaign (SSC) guidelines provide a strong recommendation to rapidly administer a minimum of 30 mL/kg crystalloid solution intravenously in all patients with septic shock and those with elevated blood lactate levels. However, there is no credible evidence to support this recommendation. In fact, recent findings from experimental, observational and randomized clinical trials demonstrate improved outcomes with a more restrictive approach to fluid resuscitation. Accumulating evidence suggests that aggressive fluid resuscitation is harmful. Paradoxically, excess fluid administration may worsen shock. In this review, we critically evaluate the scientific evidence for a weight-based fluid resuscitation approach. Furthermore, the potential mechanisms and consequences of harm associated with fluid resuscitation are discussed. Finally, we recommend an individualized, conservative and physiologic guided approach to fluid resuscitation.

Description

Keywords

Citation

Source

Journal of Thoracic Disease

Type

Journal article

Book Title

Entity type

Access Statement

Open Access

License Rights

CC BY-NC-ND 4.0

DOI

10.21037/jtd.2019.12.84

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