Current teaching and guidelines suggest that aggressive fluid resuscitation is the best initial approach to the patient with hemodynamic instability. The source of this wisdom is difficult to discern, however, Early Goal Directed therapy (EGDT) as championed by Rivers et al. and the Surviving Sepsis Campaign Guidelines appears to have established this as the irrefutable truth. However, over the...

A number of concerns have been raised regarding the advisability of the classic principles of aggressive crystalloid resuscitation in traumatic hemorrhagic shock. This issue reviews the advances that have led to a shift in the emergency department (ED) protocols in resuscitation from shock state, including recent literature regarding the new paradigm for the treatment of traumatic hemorrhagic s...

Initial fluid resuscitation in conjunction with temporary hemostasis should aim at maintenance of vital organ perfusion above critical levels. Judicious use of fluids is indicated in this early stage. Complete volume replacement is done once permanent hemostasis has been achieved. Mild (20%-40%) hemodilution produces hypercoagulability, while further hemodilution results in hypocoagulability. R...

The clinical determination of the intravascular volume can be extremely difficult in critically ill and injured patients as well as those undergoing major surgery. This is problematic because fluid loading is considered the first step in the resuscitation of hemodynamically unstable patients. Yet, multiple studies have demonstrated that only approximately 50% of hemodynamically unstable patient...

OBJECTIVE To understand the fundamental drivers, and their relative importance, of doctors' and nurses' choice of resuscitation fluid in critically ill patients in Australia and New Zealand. DESIGN A discrete choice experiment (DCE) administered via an online survey. Respondents were presented with one of four randomly selected DCE choice sets, each including five patient scenarios. The respo...

The administration of intravenous fluid to critically ill patients is one of the most common, but also one of the most fiercely debated, interventions in intensive care medicine. Even though many thousands of patients have been enrolled in large trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Critically ill patients are significantly heterogene...

INTRODUCTION In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia. PURPOSE ...

Acute pancreatitis is an acute inflammation of the pancreas associated with a high morbidity and even the risk of mortality [1, 2]. To date, there exists no specific treatment for this disease [3, 4, 5] and fluid therapy forms the cornerstone of management of these patients who present acutely to emergency departments around the world. There is a need to review the data on fluid resuscitation i...

Trauma fluid resuscitation continues to be a hotly debated issue. There is overwhelming experimental evidence to suggest that administration of resuscitation fluids is not entirely innocuous. Aggressive intravenous crystalloid administration in the presence of uncontrolled hemorrhage promotes continued bleeding and increases mortality. However this is countered by concerns that avoidance of flu...

Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended...