Starling's equation and bedside critical care

Abstract

Two landmark studies suggest that fluid management affects outcomes of critically ill patients. Early intravascular resuscitation reduced mortality of patients with sepsis/ systemic inflammatory response syndrome [1], whereas fluid restriction reduced duration of invasive ventilation of patients with lung injury [2]. Since sepsis is the most common cause of lung injury, these data may seem contradictory. Although future studies will clarify optimal end points of resuscitation, the purpose of this article is to review how Starling's equation explains and unifies these seminal observations [1,2]. Consider critical illness as metaphor with flood (resuscitation) and ebb (recovery) phases.