Fluids and sepsis: changing the paradigm of fluid therapy: a case report.
BACKGROUND
Over the past 16 years, sepsis management has been guided by large-volume fluid administration to achieve certain hemodynamic optimization as advocated in the Rivers protocol. However, the safety of such practice has been questioned because large-volume fluid administration is associated with fluid overload and carries the worst outcome in patients with sepsis. Researchers in multiple studies have declared that using less fluid leads to increased survival, but they did not describe how to administer fluids in a timely and appropriate manner.


METHODS
An 86-year-old previously healthy Sundanese man was admitted to the intensive care unit at our institution with septic shock, acute kidney injury, and respiratory distress. Standard care was implemented during his initial care in the high-care unit; nevertheless, his condition worsened, and he was transferred to the intensive care unit. We describe the timing of fluid administration and elaborate on the amount of fluids needed using a conservative fluid regimen in a continuum of resuscitated sepsis.


CONCLUSIONS
Because fluid depletion in septic shock is caused by capillary leak and pathologic vasoplegia, continuation of fluid administration will drive intravascular fluid into the interstitial space, thereby producing marked tissue edema and disrupting vital oxygenation. Thus, fluids have the power to heal or kill. Therefore, management of patients with sepsis should entail early vasopressors with adequate fluid resuscitation followed by a conservative fluid regimen.
Department of Anesthesiology and Critical Care Medicine, 3rd floor, Siloam Hospitals Lippo Village, Jalan Siloam No. 6, Karawaci, 15811, Tangerang, Banten, Indonesia. icujournals@gmail.com.
Hori
H
Hariyanto
Department of Anesthesiology, Faculty of Medicine, Universitas Pelita Harapan, Jalan Boulevard Jendral Sudirman, Lippo Karawaci, Tangerang, 15811, Indonesia.
Corry Quando
CQ
Yahya
Department of Anesthesiology, Faculty of Medicine, Universitas Pelita Harapan, Jalan Boulevard Jendral Sudirman, Lippo Karawaci, Tangerang, 15811, Indonesia.
Monika
M
Widiastuti
Department of Anesthesiology and Critical Care Medicine, 3rd floor, Siloam Hospitals Lippo Village, Jalan Siloam No. 6, Karawaci, 15811, Tangerang, Banten, Indonesia.
Primartanto
P
Wibowo
Department of Anesthesiology and Critical Care Medicine, 3rd floor, Siloam Hospitals Lippo Village, Jalan Siloam No. 6, Karawaci, 15811, Tangerang, Banten, Indonesia.
Oloan Eduard
OE
Tampubolon
D000058:Accidental Falls; D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D003422:Critical Care / Q000379:methods; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D019148:Neuromuscular Blockade; D017410:Practice Guidelines as Topic; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents
Case report; Fluid management; Fluid overload; Geriatric; Sepsis; Septic shock