Choice of fluids in critically ill patients

Abstract

BackgroundFluids are by far the most commonly administered intravenous treatment in patient care. During critical illness, fluids are widely administered to maintain or increase cardiac output, thereby relieving overt tissue hypoperfusion and hypoxia.Main textUntil recently, because of their excellent safety profile, fluids were not considered “medications”. However, it is now understood that intravenous fluid should be viewed as drugs. They affect the cardiovascular, renal, gastrointestinal and immune systems. Fluid administration should therefore always be accompanied by careful consideration of the risk/benefit ratio, not only of the additional volume being administered but also of the effect of its composition on the physiology of the patient. Apart from the need to constantly assess fluid responsiveness, it is also important to periodically reconsider the type of fluid being administered and the evidence regarding the relationship between specific disease states and different fluid solutions.ConclusionsThe current review presents the state of the art regarding fluid solutions and presents the existing evidence on routine fluid management of critically ill patients in specific clinical settings (sepsis, Adult Respiratory Distress Syndrome, major abdominal surgery, acute kidney injury and trauma).Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0669-3) contains supplementary material, which is available to authorized users.

Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature

“…The utility of volume expansion with colloids and their use in comparison to crystalloids has been studied extensively for decades 1,25,26 . First introduced in the 1940s, the first human protein isolated for clinical use was iso‐oncotic (4%–5%) albumin 27,28 .…”

“…Intravenous fluid therapy is frequently used for postoperative resuscitation in patients undergoing cardiac surgery 1–4 . The initiation of fluid therapy is often in response to signs of inadequate tissue perfusion and intravascular depletion, such as arterial hypotension, poor urine output, elevated serum lactate levels, and hemodynamic parameters derived from the use of pulmonary artery catheters and continuous cardiac output (CO) monitoring in the intensive care unit (ICU) 5–7 .…”

Post-Operative Restrictive Fluid Therapy for Abdominal Compartment Syndrome in ICU: Case Report

“…Some small trials have shown that a more restrictive fluid regimen led to fewer complications and a shorter hospital stay [3]. [4]. After successful treatment in first phase of septic shock, the patient may either further recover, entering the "no-flow" state, followed by a third hit, usually resulting from global increased permeability syndrome with ongoing fluid accumulation due to capillary leak.…”

Effect of a 3% gelatin solution on urinary KIM-1 levels in patients after thyroidectomy: a preliminary randomized controlled trial

“…Colloids are fluids used primarily for a hemorrhagic shock when the rapid securing of blood products is not possible 18 – 20 . Gelatin preparations can be extremely useful in these situations, but establishing their adverse effects on kidney function is essential 21 , 22 .…”