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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2014

Open Access 01-12-2014 | Review

Choices in fluid type and volume during resuscitation: impact on patient outcomes

Authors: Alena Lira, Michael R Pinsky

Published in: Annals of Intensive Care | Issue 1/2014

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Abstract

We summarize the emerging new literature regarding the pathophysiological principles underlying the beneficial and deleterious effects of fluid administration during resuscitation, as well as current recommendations and recent clinical evidence regarding specific colloids and crystalloids. This systematic review allows us to conclude that there is no clear benefit associated with the use of colloids compared to crystalloids and no evidence to support the unique benefit of albumin as a resuscitation fluid. Hydroxyethyl starch use has been associated with increased acute kidney injury (AKI) and use of renal replacement therapy. Other synthetic colloids (dextran and gelatins) though not well studied do not appear superior to crystalloids. Normal saline (NS) use is associated with hyperchloremic metabolic acidosis and increased risk of AKI. This risk is decreased when balanced salt solutions are used. Balanced crystalloid solutions have shown no harmful effects, and there is evidence for benefit over NS. Finally, fluid resuscitation should be applied in a goal-directed manner and targeted to physiologic needs of individual patients. The evidence supports use of fluids in volume-responsive patients whose end-organ perfusion parameters have not been met.
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Metadata
Title
Choices in fluid type and volume during resuscitation: impact on patient outcomes
Authors
Alena Lira
Michael R Pinsky
Publication date
01-12-2014
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2014
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-014-0038-4

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