Fluid Therapy in the Critically Ill Patient

Critically ill patients may be at higher risk for fluid overload and the development of interstitial edema due to damage to the endothelial glycocalyx, myocardial dysfunction, vasoplegia, renal dysfunction, increased vascular permeability, and hypoalbuminemia. While isotonic crystalloids are commonly used for resuscitation of hypovolemic shock, their use should be limited in critically ill patients to avoid complications, including the development of interstitial edema. Blood products should be considered for resuscitation of hemorrhagic shock to limit the volume of crystalloids required. To limit risks associated with fluid administration, fluid resuscitation should be guided by fluid responsiveness.