Fluid Management in Septic Shock: a Review of Physiology, Goal-Directed Therapy, Fluid Dose, and Selection

Abstract

Purpose of Review: To review our current understanding of the intravascular space, therapeutic goals of fluid resuscitation, suitable endpoints of resuscitation, and appropriate choice of fluids. Recent Findings: An evolving understanding of the endothelium and glycocalyx has improved our understanding of the intravascular space. More aggressive fluid resuscitation after adoption of the Surviving Sepsis Campaign guidelines has led to an initial reduction in mortality associated with sepsis; however, the untoward effects of volume overload are increasingly evident. Fluid responsiveness is likely the best endpoint for resuscitation. Albumin has not been shown to be superior to crystalloids in the resuscitation of septic patients. As 0.9% saline has been associated with acute kidney injury, balanced buffered salt solutions are considered the preferred resuscitation fluid of choice. Summary: Fluid resuscitation with buffered crystalloid solutions is preferred and should likely continue if the patient remains fluid responsive. This strategy risks volume overload.