Fluids in septic shock: Crystalloid, colloids, or blood?

Nicholas Namias, Andrew Gaugler

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Controversy persists over the type of fluids that should be used in the resuscitation of septic patients. The goal of this chapter is to review some of the recent literature examining this controversy and to distill the findings into recommendations for the practicing intensivist. In short, no randomized trials have definitively shown a mortality benefit of any one type of fluid over another. Trends toward differences in secondary outcomes have been insinuated, but none in a rigorous fashion can lead to definitive recommendations. The adverse effects of hydroxyethyl starches, in the absence of any improved outcomes with their use, lead the authors to recommend they not be used in the resuscitation of sepsis. Absence of proof is not proof of absence; therefore, the authors continue to use albumin solutions in special patient subsets who may benefit from smaller infusion volumes or increased oncotic load. Due to the consideration of cost, crystalloids should comprise the bulk of the fluid used in the resuscitation of sepsis, but albumin solutions remain an alternative at the discretion of the treating physician. There is no evidence to recommend blood as a resuscitative fluid. The standard recommendation to allow hemoglobin to fall to 7 gm/dL applies.

Original languageEnglish (US)
Title of host publicationComplications in Acute Care Surgery
Subtitle of host publicationThe Management of Difficult Clinical Scenarios
PublisherSpringer International Publishing
Pages15-23
Number of pages9
ISBN (Electronic)9783319423760
ISBN (Print)9783319423746
DOIs
StatePublished - Jan 1 2016

Keywords

  • Albumin
  • Colloid
  • Crystalloid
  • Early goal-directed therapy
  • Hetastarch
  • Hydroxyethyl starch
  • Resuscitation
  • Sepsis
  • Septic shock
  • Transfusion

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Namias, N., & Gaugler, A. (2016). Fluids in septic shock: Crystalloid, colloids, or blood? In Complications in Acute Care Surgery: The Management of Difficult Clinical Scenarios (pp. 15-23). Springer International Publishing. https://doi.org/10.1007/978-3-319-42376-0_2