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Resuscitation fluids.

Jonathan D Casey1, Ryan M Brown, Matthew W Semler

  • 1Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Current Opinion in Critical Care
|September 25, 2018
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Summary
This summary is machine-generated.

Intravenous fluid resuscitation choice impacts kidney injury and death risk in critically ill adults. Balanced crystalloids are generally safer than colloids or 0.9% saline, with fluid dosing guided by hemodynamic response.

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Area of Science:

  • Critical care medicine
  • Nephrology
  • Intensive care

Background:

  • Intravenous fluid administration is a cornerstone of critical care.
  • Optimal fluid composition and dosage remain subjects of ongoing research.
  • Understanding fluid resuscitation effects on organ function and outcomes is crucial.

Purpose of the Study:

  • To review recent evidence on fluid resuscitation in critically ill patients.
  • To evaluate the impact of fluid composition and dose on pathophysiology, organ function, and clinical outcomes.
  • To provide guidance on fluid management strategies.

Main Methods:

  • Systematic review of recent evidence.
  • Analysis of studies on fluid composition (crystalloids vs. colloids, balanced vs. 0.9% saline).
  • Evaluation of different fluid dosing strategies (liberal, restrictive, hemodynamic responsiveness-guided).

Main Results:

  • Fluid composition significantly influences kidney injury and mortality risk.
  • Semisynthetic colloids are associated with higher risks compared to crystalloids.
  • 0.9% sodium chloride may increase risk compared to balanced crystalloids.
  • The optimal fluid dosing strategy (liberal, restrictive, or hemodynamic responsiveness-guided) for sepsis or major surgery is still uncertain.

Conclusions:

  • Balanced crystalloids are recommended as the primary fluid choice.
  • Initial fluid resuscitation for shock may involve 2-3 liters.
  • Hemodynamic responsiveness measures should guide further fluid administration.
  • Careful consideration of fluid composition and dose is essential for optimizing patient outcomes.