Fluid resuscitation in severe sepsis and septic shock: an evidence-based review.
OBJECTIVE
In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for fluid resuscitation in severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.


METHODS
The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee.


METHODS
The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591.


CONCLUSIONS
Fluid resuscitation of severe sepsis may consist of natural or artificial colloids or crystalloids. Fluid challenge should be administered and repeated based on response (increase in blood pressure and urine output) and tolerance (evidence of intravascular volume overload).
Vincent
Jean-Louis
JL
Klinik für Anaesthesie, Operative Intensivmedizin und Schmerztherapie, Vivantes-Klinikum Neukölln, Berlin, Germany.
Gerlach
Herwig
H
D003245:Consensus Statements as Topic; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D012151:Resuscitation / Q000379:methods*; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*