Fluid as a Drug: Balancing Resuscitation and Fluid Overload in the Intensive Care Setting.
Intravenous fluid resuscitation is ubiquitous throughout medicine and is often considered a benign procedure. Yet, there is now clear recognition of the potential harms of fluid overload after initial resuscitation. In recent years, there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks. Studies have examined colloids, such as albumin and starches, against the clinical standard of crystalloids. In addition, evidence has emerged to suggest that outcomes may be different between resuscitation with chloride-rich vs balanced crystalloid solutions. In this article, we review the current literature regarding choice of intravenous fluids for resuscitation in the intensive care setting and describe the dangers associated with fluid overload in critically ill patients.
Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
Matthew D
MD
McGuire
Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI. Electronic address: mheung@umich.edu.
Michael
M
Heung
D000418:Albumins / Q000627:therapeutic use; D002712:Chlorides / Q000627:therapeutic use; D003102:Colloids / Q000627:therapeutic use*; D003422:Critical Care; D000077324:Crystalloid Solutions; D004573:Electrolytes / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods*; D012965:Sodium Chloride / Q000627:therapeutic use; D014883:Water-Electrolyte Imbalance / Q000209:etiology
D000418:Albumins; D002712:Chlorides; D003102:Colloids; D000077324:Crystalloid Solutions; D004573:Electrolytes; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D012965:Sodium Chloride; C048013:Plasmalyte A
Balanced solutions; Colloids; Crystalloids; Fluid overload; Resuscitation