title: Evolution of fluid therapy.
abstract: The human organism consists of evolutionary conserved mechanisms to prevent death from hypovolaemia. Intravenous fluid therapy to support these mechanisms had first been published about 180 years ago. The present review depicts the evolution of fluid therapy from early, not well-defined solutions up to modern balanced fluids. Notably, evidence accumulates that the most commonly used fluid (i.e. 0.9% saline) has no advantage over balanced solutions, increases the risk of acute kidney injury and should therefore be abandoned. Notably, in published trials, the prognostically important 'golden hours' of shock, where fluid therapy may be essential, have not been adequately addressed. It is therefore unclear whether negative data on colloids in some trials reflect real harm or rather inadequate use. Future studies should focus on optimal protocols for initiation, dosing and discontinuation of fluid therapy in specific disease entities. Moreover, the practice of de-resuscitation after fluid-based haemodynamic stabilization should be further investigated.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital of Muenster, Muenster, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Kampmeier
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital of Muenster, Muenster, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rehberg
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital of Muenster, Muenster, Germany. Electronic address: ertmer@anit.uni-muenster.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D000818:Animals; D003102:Colloids / Q000008:administration & dosage / Q000009:adverse effects; D016638:Critical Illness / Q000628:therapy*; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D015532:Rehydration Solutions / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D003102:Colloids; D015532:Rehydration Solutions
keywords: acute kidney injury; fluid therapy; hydroxyethyl starch; hypovolaemia; shock