Early fluid resuscitation in sepsis: evidence and perspectives.
Hemodynamic instability plays a major role in the pathogenesis of systemic inflammation, tissue hypoxia, and multiple organ dysfunction in sepsis. Aggressive fluid replacement is one of the key interventions for the hemodynamic support in severe sepsis. In this scenario, the ability to restore the imbalance between tissue oxygen demand and supply, the heterogeneity in microcirculation, and endothelial dysfunction in the early stages of sepsis are associated with reduced mortality. In 2001, a single-center randomized controlled trial showed impressive reductions in hospital mortality when patients presenting to the emergency department with severe sepsis were treated with an aggressive protocol of fluids, blood transfusion, and inotropes aiming to improve tissue perfusion. However, external validation of this trial remains to be carried out. To date, there is no unequivocal evidence that such strategy is both universally feasible and effective. In the present article, we review the current evidence and comment on the future perspectives on early fluid resuscitation in severe sepsis.
Bozza
Fernando A
FA
Intensive Care Unit, Instituto de Pesquisa Evandro Chagas, IOC, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. bozza.fernando@gmail.com
Carnevale
Renata
R
Japiassú
André Miguel
AM
Castro-Faria-Neto
Hugo Caire
HC
Angus
Derek C
DC
Salluh
Jorge I F
JI
D000818:Animals; D001803:Blood Transfusion; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000077324:Crystalloid Solutions; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D005544:Forecasting; D006439:Hemodynamics; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D008833:Microcirculation; D015337:Multicenter Studies as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D018805:Sepsis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions