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Title: A rational approach to fluid therapy in sepsis.
Austin Authors: Marik, P;Bellomo, Rinaldo 
Affiliation: Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Av, Suite 410, Norfolk, VA 23507, USA
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Mar-2016
Date: 2015-10-27
Publication information: British journal of anaesthesia 2016; 116(3): 339-49
Abstract: Aggressive fluid resuscitation to achieve a central venous pressure (CVP) greater than 8 mm Hg has been promoted as the standard of care, in the management of patients with severe sepsis and septic shock. However recent clinical trials have demonstrated that this approach does not improve the outcome of patients with severe sepsis and septic shock. Pathophysiologically, sepsis is characterized by vasoplegia with loss of arterial tone, venodilation with sequestration of blood in the unstressed blood compartment and changes in ventricular function with reduced compliance and reduced preload responsiveness. These data suggest that sepsis is primarily not a volume-depleted state and recent evidence demonstrates that most septic patients are poorly responsive to fluids. Furthermore, almost all of the administered fluid is sequestered in the tissues, resulting in severe oedema in vital organs and, thereby, increasing the risk of organ dysfunction. These data suggest that a physiologic, haemodynamically guided conservative approach to fluid therapy in patients with sepsis would be prudent and would likely reduce the morbidity and improve the outcome of this disease.
DOI: 10.1093/bja/aev349
ORCID: 0000-0002-1650-8939
Journal: British journal of anaesthesia
PubMed URL: 26507493
Type: Journal Article
Subjects: central venous pressure
fluid therapy
pulmonary edema
septic shock
Appears in Collections:Journal articles

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