Abstract
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.
Highlights
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question
*Correspondence: rinaldo.bellomo@austin.org.au 2Australian and New Zealand Intensive Care Research Centre, Commercial Road, Melbourne, Victoria 3181, Australia Full list of author information is available at the end of the article
Overall 48-hour mortality was 9.5% and most deaths occurred within 24 hours, but a striking difference was found between the control group and the bolus fluid groups: 48-hour mortality rates were 7.3%, 10.6%, and 10.5% for the control, albumin bolus, and 0.9% bolus groups, respectively
Summary
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. Current guidelines for the acute management of severe sepsis in pediatric and adult patients place prime importance on early, rapid, and substantial infusion of intravenous fluids [1,2]. In both adults and children, no controlled data exist that increases in cardiac output due to volume expansion are beneficial or even reliably achieved [11].
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