Abstract
Intravenous fluids (IVFs) represent a basic therapeutic intervention utilized in septic shock. Unfortunately, the optimal method for administering IVFs to maximize patient outcomes is unknown. A meta-analysis of four randomized trials of goal-directed therapy did not demonstrate a significant reduction in mortality (odds ratio 0.609; 95% confidence interval 0.363 to 1.020; P = 0.059), whereas 18 trials with historical controls showed a significant increase in survival (odds ratio 0.580; 95% confidence interval 0.501 to 0.672; P < 0.0001). Based on these data, clinicians should be aware of the potential for harm due to the excessive administration of IVFs to patients with septic shock.
Highlights
Intravenous fluids (IVFs) are one of the most common therapies provided to critically ill patients
IVF administration is largely empiric, goal-directed approaches have been used in an attempt to optimize resuscitation in unstable patients [1,2]
Excessive use of any therapeutic agent can be associated with potential harm; excessive use of antibiotics [3,4], sedation [5,6], tidal volume [7,8], transfusions [9], and glucose [10] have all been linked to unfavorable patient outcomes
Summary
Intravenous fluids (IVFs) are one of the most common therapies provided to critically ill patients. IVF administration is largely empiric, goal-directed approaches have been used in an attempt to optimize resuscitation in unstable patients [1,2]. Excessive use of any therapeutic agent can be associated with potential harm; excessive use of antibiotics [3,4], sedation [5,6], tidal volume [7,8], transfusions [9], and glucose [10] have all been linked to unfavorable patient outcomes. A systematic approach for delivery of IVFs in critically ill patients does not exist. This is partly related to the various conditions managed in the ICU setting, as well as the varied approaches to IVF administration and availability of different IVF types
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