Intravenous fluids in sepsis: what to use and what to avoid

Septic shock is one of the most common and life-threatening conditions afflicting critically ill patients. Intravenous volume resuscitation is considered an initial and very important step in management. The most suitable fluid for volume expansion during septic shock remains unclear. In this review, we focus on the benefits and adverse effects of the most commonly used intravenous fluids in critically ill septic patients.

The debate about the benefits of colloids over crystalloids has been ongoing for the last few decades. With recent literature showing apparent harm from the use of hydroxyethyl starches (HESs), and given the growing concerns of adverse renal and acid-base abnormalities associated with 0.9% saline compared with balanced crystalloid solutions, it may be time to change the nature of the 'fluid debate'.

Crystalloids should still be considered as the first-choice drug for volume resuscitation in patients with septic shock. Colloids such as albumin can be considered in some clinical settings. HES should be avoided. Balanced crystalloids might have an important role to play in the management of septic shock.