Clinical controversies in the management of critically ill patients with severe sepsis: resuscitation fluids and glucose control.
Severe sepsis with multiple organ dysfunction remains the most common cause of death for patients treated in intensive care units. As there is no specific treatment for severe sepsis, current management consists of antibiotics, source control and the use of supportive therapies to sustain life while waiting for the adverse effects of sepsis-induced organ dysfunction to subside. Despite the central role of supportive therapies, few have been subjected to rigorous evaluation; two exceptions are the choice of resuscitation fluid and intensity of glucose control. Current data support the use of a crystalloid fluid with the addition of albumin when needed for fluid resuscitation. Administration of hydroxyethyl starch is harmful and should be avoided. Stress hyperglycemia should be treated when blood glucose concentration exceeds 180 mg/dL (10.0 mmol/L) and when insulin therapy is needed it should be targeted to a blood glucose concentration of 144-180 mg/dL (8-10 mmol/L).
The George Institute for Global Health and Royal North Shore Hospital; The University of Sydney; St Leonards, NSW Australia.
Simon
S
Finfer
D000418:Albumins / Q000494:pharmacology*; D001786:Blood Glucose; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000379:methods*; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects; D006943:Hyperglycemia / Q000188:drug therapy; D007328:Insulin / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use*; D009102:Multiple Organ Failure / Q000503:physiopathology / Q000628:therapy; D012151:Resuscitation / Q000379:methods; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
D000418:Albumins; D001786:Blood Glucose; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007328:Insulin; D007552:Isotonic Solutions; D005947:Glucose
albumin; fluid therapy; glucose control; hetastarch; insulin; normal saline; outcome; severe sepsis; stress hyperglycemia