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Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
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Balanced crystalloids for septic shock resuscitation.

Thiago Domingos Corrêa1, Alexandre Biasi Cavalcanti2, Murillo Santucci Cesar de Assunção1

  • 1Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil.

Revista Brasileira De Terapia Intensiva
|January 19, 2017
PubMed
Summary

Choosing the right fluid for septic shock resuscitation is debated. Unbalanced crystalloids may increase risks, while balanced crystalloids need further study for safety and effectiveness in septic shock patients.

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Emergency Medicine

Background:

  • Fluid resuscitation is vital for septic shock, but the optimal fluid type remains controversial.
  • Evidence suggests fluid choice impacts patient outcomes in sepsis.
  • Unbalanced crystalloids, like 0.9% saline, are linked to acid-base/electrolyte disturbances and acute kidney injury in critically ill patients.

Purpose of the Study:

  • To review the current debate on fluid resuscitation in septic shock.
  • To evaluate the potential risks of unbalanced crystalloids versus balanced crystalloids.
  • To highlight the need for high-quality trials on balanced crystalloid use in septic shock.

Main Methods:

  • Review of existing literature on fluid resuscitation in septic shock.
  • Analysis of evidence linking crystalloid types to patient outcomes, including acid-base balance, electrolyte disorders, and acute kidney injury.
  • Identification of knowledge gaps regarding balanced crystalloid efficacy and safety.

Main Results:

  • Crystalloids are first-line for septic shock, but no definitive recommendation exists for specific solutions.
  • Unbalanced crystalloids may increase the risk of adverse events like acute kidney injury and mortality.
  • Balanced crystalloids are proposed as a safer alternative, but require more robust clinical validation.

Conclusions:

  • The choice of crystalloid for septic shock resuscitation requires careful consideration due to potential adverse effects of unbalanced solutions.
  • Further well-designed, multicenter, pragmatic, randomized controlled trials are essential to determine the safety and effectiveness of balanced crystalloids in septic shock.
  • Optimal fluid management in septic shock remains an area needing further research to improve patient outcomes.