The influence of volume management on outcome.
OBJECTIVE
Fluid (volume) therapy is an integral component in the management of critically ill patients and fluid management may influence outcome. There is much controversy, however, about the type, timing and amount of fluid therapy. Here, we discuss the evidence available to guide such choices.


RESULTS
Fluid therapy is widely endorsed for resuscitation of critically ill patients across a range of conditions. Yet, the approach to fluid therapy is subject to substantial variation in clinical practice. Emerging data show that the choice, timing and amount of fluid therapy may affect clinical outcomes. Synthetic colloids may increase the risk of acute kidney injury. Albumin may benefit hypoalbuminemic patients with sepsis and acute lung injury but may worsen outcome in traumatic brain injury. Early administration of fluid therapy in sepsis may improve survival but may be unnecessary in patients with penetrating trauma. Later fluid therapy in acute lung injury patients will increase the duration of ventilator dependence without achieving better survival. A positive cumulative balance likely contributes to increased morbidity and mortality after major surgery.


CONCLUSIONS
Emerging evidence shows that choice, timing and amount of fluid therapy affect outcome. Future studies need to focus on these aspects of fluid therapy by means of larger, more rigorous and blinded controlled trials.
Bagshaw
Sean M
SM
Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada.
Bellomo
Rinaldo
R
D016638:Critical Illness / Q000628:therapy*; D004334:Drug Administration Schedule; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D010952:Plasma Substitutes / Q000627:therapeutic use; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012709:Serum Albumin / Q000627:therapeutic use; D012770:Shock, Cardiogenic / Q000628:therapy; D012772:Shock, Septic / Q000628:therapy; D013514:Surgical Procedures, Operative / Q000379:methods
D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D012709:Serum Albumin