Fluids-sepsis and shock

The Composition of Saline, Lactated Ringer’s Solution, and Plasma-Lyte 148

• Aggressive IV fluid resuscitation (30 mL/kg) admin in boluses w/in 3 h of presentation
• Crystalloid as good as colloid for resuscitation (JAMA 2013;310:1809; NEJM 2014;370:1412)
• No consistently seen benefit of balanced crystalloid (LR, Plasma-Lyte) vs. NS in terms of mortality, organ failure or need for RRT (NEJM 2018;378:829 & 2022:386:815)
• NaHCO3 may ↓ mortality & need for RRT if AKI & pH <7.2 (Lancet 2018;392:31)
• Predictors of fluid responsiveness: pulse pressure variation >13% w/ respiration (Chest 2008;133:252); resp. variation in IVC diam, or >10% ↑ in pulse pressure w/ passive leg raise. Static CVP poor surrogate.
• After early resuscitation, if ALI/ARDS, target CVP 4–6 mmHg because additional fluids may be harmful → ↑ ventilator/ICU days (NEJM 2006;354:2564; Chest 2008;133:252)

see: Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults