Fluid resuscitation

Abstract

Hypovolemia is common among trauma, surgical, and intensive care unit (ICU) patients. Fluid deficits can occur in the absence of obvious blood or fluid loss secondary to either vasodilation or alterations of the endothelial barrier resulting in diffuse capillary leak (e.g., in septic patients). Sepsis is characterized by a panendothelial injury with subsequent development of increased endothelial permeability, loss of proteins, and interstitial edema leading to fluid shift from the intravascular to the interstitial compartment. In the critically ill intensive care patient, adequate volume restoration for treating noncompensatory, irreversible shock is essential. Prolonged under-resuscitation of the hypovolemic patient can have fatal consequences for organ function - lengthy uncor-rected hypovolemia will even jeopardize survival secondary to continuous release of various vasoactive substances and stimulation of cytokine cascades. Vigorous optimization of the circulating volume is a prerequisite to avoid development of Multiple Organ Dysfunction Syndrome (MODS) in the hypovolemic patient.1 In a prospective review of 111 consecutive patients who died in hospital after admission for treatment of injuries, the most common defects in patient management were related to inadequate fluid resuscitation.2 In approximately 50% of septic patients, only adequate volume replacement may reverse hypotension and restore hemodynamics.2 © 2010 Springer-Verlag US.