title: Fluid therapy for septic shock resuscitation: which fluid should be used?
abstract: Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of the most common interventions offered to critically ill patients, the most appropriate type of fluid to be used remains controversial. According to recently published clinical trials, crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients. Balanced crystalloids have theoretical advantages over the classic solutions, but there is not enough evidence to indicate it as first-line treatment. Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Thiago Domingos
authors: TD
authors: Corrêa
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Leonardo Lima
authors: LL
authors: Rocha
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Camila Menezes Souza
authors: CM
authors: Pessoa
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Eliézer
authors: E
authors: Silva
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Murillo Santucci Cesar
authors: MS
authors: de Assuncao
mesh_terms: D003422:Critical Care; D000077324:Crystalloid Solutions; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods; D012772:Shock, Septic / Q000628:therapy*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions