Resuscitation Fluids

Abstract

F luid resuscitation with colloid and crystalloid solutions is a ubiquitous intervention in acute medicine. The selection and use of resuscita-tion fluids is based on physiological principles, but clinical practice is deter-mined largely by clinician preference, with marked regional variation. No ideal resuscitation fluid exists. There is emerging evidence that the type and dose of resuscitation fluid may affect patient-centered outcomes. Despite what may be inferred from physiological principles, colloid solutions do not offer substantive advantages over crystalloid solutions with respect to hemody-namic effects. Albumin is regarded as the reference colloid solution, but its cost is a limitation to its use. Although albumin has been determined to be safe for use as a resuscitation fluid in most critically ill patients and may have a role in early sepsis, its use is associated with increased mortality among patients with traumatic brain injury. The use of hydroxyethyl starch (HES) solutions is associ-ated with increased rates of renal-replacement therapy and adverse events among patients in the intensive care unit (ICU). There is no evidence to recommend the use of other semisynthetic colloid solutions. Balanced salt solutions are pragmatic initial resuscitation fluids, although there is little direct evidence regarding their comparative safety and efficacy. The use of normal saline has been associated with the development of metabolic acidosis and acute kidney injury. The safety of hypertonic solutions has not been established. All resuscitation fluids can contribute to the formation of interstitial edema, particularly under inflammatory conditions in which resuscitation fluids are used excessively. Critical care physicians should consider the use of resuscitation fluids as they would the use of any other intravenous drug. The selection of the specific fluid should be based on indications, contraindications, and potential toxic effects in order to maximize efficacy and minimize toxicity. His t or y of Fluid R e susci tat ion