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Fluid Therapy in Resuscitated Sepsis^*

Less Is More

^* From the Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.

Correspondence to: Gregory A. Schmidt, MD, FCCP, Professor of Medicine, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242; e-mail: gregory-a-schmidt{at}uiowa.edu

Abstract

Fluid infusion may be lifesaving in patients with severe sepsis, especially in the earliest phases of treatment. Following initial resuscitation, however, fluid boluses often fail to augment perfusion and may be harmful. In this review, we seek to compare and contrast the impact of fluids in early and later sepsis; show that much fluid therapy is clinically ineffective in patients with severe sepsis; explore the detrimental aspects of excessive volume infusion; examine how clinicians assess the intravascular volume state; appraise the potential for dynamic indexes to predict fluid responsiveness; and recommend a clinical approach.

Key Words: fluids • fluid responsiveness • preload resuscitation • sepsis