Fluid management in sepsis: 5 reasons why less fluid might be more rational - Critical Care Science (CCS)

1^ST REASON: FLUID HEMODYNAMIC EFFECTS ARE FLEETING

After the administration of intravenous crystalloids (the most common type of fluid expansion in shock), the increase in CO does not last for more than one hour. In a prospective study conducted by Nunes et al., patients with circulatory shock received a fluid challenge of 500mL of crystalloids. Although CO peaked at 30 minutes, it progressively decreased thereafter, returning to baseline values after 60 minutes.⁽⁾

As a consequence, after the initial fluid administration recommended by international guidelines (the famous “rapid 30mL/kg of crystalloid”),⁽⁾ unstable patients will probably require vasoactive drugs. In a recent trial, a restrictive fluid strategy (which favored early vasopressor infusion) after initial fluid administration was not associated with a different mortality rate compared to a liberal strategy.⁽⁾ However, this strategy might mitigate the use of short-lived therapy (fluid administration) in favor of early use of long-lived titratable efficacious therapy in sepsis-induced vasodilated hypotension.

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