Early fluid resuscitation in sepsis: evidence and perspectives

• Published in: Shock (Augusta, Ga.) Vol. 34 Suppl 1; no. 7; pp. 40 - 43
• Main Authors: Bozza, Fernando A, Carnevale, Renata, Japiassú, André Miguel, Castro-Faria-Neto, Hugo Caire, Angus, Derek C, Salluh, Jorge I F
• Format: Journal Article
• Language: English
• Published: United States 01-09-2010
• Subjects: Animals; Blood Transfusion; Cardiotonic Agents - therapeutic use; Combined Modality Therapy; Emergency Service, Hospital; Evidence-Based Medicine; Fluid Therapy; Forecasting; Hemodynamics; Humans; Isotonic Solutions - therapeutic use; Meta-Analysis as Topic; Microcirculation; Multicenter Studies as Topic; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Reproducibility of Results; Resuscitation - methods; Sepsis - drug therapy; Sepsis - mortality; Sepsis - physiopathology; Sepsis - therapy; Treatment Outcome
• ISSN: 1073-2322; 1540-0514
• DOI: 10.1097/SHK.0b013e3181e7e668

Hemodynamic instability plays a major role in the pathogenesis of systemic inflammation, tissue hypoxia, and multiple organ dysfunction in sepsis. Aggressive fluid replacement is one of the key interventions for the hemodynamic support in severe sepsis. In this scenario, the ability to restore the imbalance between tissue oxygen demand and supply, the heterogeneity in microcirculation, and endothelial dysfunction in the early stages of sepsis are associated with reduced mortality. In 2001, a single-center randomized controlled trial showed impressive reductions in hospital mortality when patients presenting to the emergency department with severe sepsis were treated with an aggressive protocol of fluids, blood transfusion, and inotropes aiming to improve tissue perfusion. However, external validation of this trial remains to be carried out. To date, there is no unequivocal evidence that such strategy is both universally feasible and effective. In the present article, we review the current evidence and comment on the future perspectives on early fluid resuscitation in severe sepsis.