Fluid management in shock patients : New targets in the initial phase of shock

Abstract

Early i.v. fluid administration is a cornerstone in modern therapy of shock, especially in septic shock. However, there is much uncertainty concerning the amount and rate of fluid and which goals and measures could guide fluid management. Administering the optimal fluid volume is important because fluid overload can lead to severe negative consequences like organ failure and worsening of patient's outcome. This review aims to describe the importance of fluid therapy and discuss possible strategies in fluid management as well as possible measurements and goals to guide such therapy. There is no single measurement to guide fluid management alone. It is important to assess fluid responsiveness, which together with multiple other parameters can be used to repeatedly assess optimal fluid management. However, it has also not been shown that assessing fluid responsiveness can improve outcome. After the initial resuscitation, further fluid administration should be determined by individual patient factors and measures of fluid responsiveness. Amore restrictive fluid management with early vasopressor administration seems to be increasingly used in modern fluid management. However many questions regarding optimal fluid management remain to be solved.