Fluid resuscitation in the critically ill: what is the next challenge?

In 2010 the SAFE-TRIPS investigators reported on resuscitation fluid administration in 391 intensive care units (ICUs) in 25 countries.(1) The study found that more than one third of patients in the ICUs received resuscitation fluids on the study day and that the choice of fluid administered was determined by local practice and habit rather than by any identifiable patient characteristic. Given that many thousands of patients receive resuscitation fluid each day, it is an intervention that has the potential to result in either great benefit or great harm. Although recently published trials by clinician investigators have dramatically increased the evidence base in this area,(2-9) some questions remain unanswered.