Importance of intravenous fluid dose and composition in surgical ICU patients.

Published

Journal Article (Review)

PURPOSE OF REVIEW: This review discusses the importance of intravenous fluid dose and composition in surgical ICU patients. On the basis of updated physiologic postulates, we suggest guidelines for the use of crystalloids and colloids. Goal-directed fluid therapy is advocated as a means for avoiding both hypovolemia and hypervolemia. RECENT FINDINGS: Integrity of the endothelial surface layer (ESL) and 'volume context' are key determinants of fluid disposition. During critical illness the ESL is compromised. Optimal resuscitation may be guided by functional measures of fluid responsiveness with some caveats. The best approach may be to use physiologically balanced crystalloids for hypovolemic resuscitation and colloids for euvolemic hemodynamic augmentation. SUMMARY: The routine replacement of unmeasured presumed fluid deficits is not appropriate. In critically ill patients, resuscitation with intravenous fluids should produce a demonstrable enhancement of perfusion. Individualized goal-directed therapy using functional hemodynamic parameters can optimize resuscitation and 'deresuscitation'.

Full Text

Duke Authors

Cited Authors

  • Raghunathan, K; McGee, WT; Higgins, T

Published Date

  • August 2012

Published In

Volume / Issue

  • 18 / 4

Start / End Page

  • 350 - 357

PubMed ID

  • 22732434

Pubmed Central ID

  • 22732434

Electronic International Standard Serial Number (EISSN)

  • 1531-7072

International Standard Serial Number (ISSN)

  • 1070-5295

Digital Object Identifier (DOI)

  • 10.1097/mcc.0b013e328355598c

Language

  • eng