Conservative fluid therapy in septic shock: an example of targeted therapeutic minimization

Catherine Chen; Marin H Kollef

doi:10.1186/s13054-014-0481-5

Conservative fluid therapy in septic shock: an example of targeted therapeutic minimization

Crit Care. 2014 Aug 29;18(4):481. doi: 10.1186/s13054-014-0481-5.

Authors

Catherine Chen¹, Marin H Kollef²

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO, 63110, USA. [email protected].
² Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO, 63110, USA. [email protected].

Abstract

Intravenous fluids (IVFs) represent a basic therapeutic intervention utilized in septic shock. Unfortunately, the optimal method for administering IVFs to maximize patient outcomes is unknown. A meta-analysis of four randomized trials of goal-directed therapy did not demonstrate a significant reduction in mortality (odds ratio 0.609; 95% confidence interval 0.363 to 1.020; P = 0.059), whereas 18 trials with historical controls showed a significant increase in survival (odds ratio 0.580; 95% confidence interval 0.501 to 0.672; P < 0.0001). Based on these data, clinicians should be aware of the potential for harm due to the excessive administration of IVFs to patients with septic shock.

Publication types

Review

MeSH terms

Body Fluids / physiology
Fluid Therapy / methods*
Humans
Observational Studies as Topic / methods
Randomized Controlled Trials as Topic / methods
Shock, Septic / diagnosis*
Shock, Septic / physiopathology
Shock, Septic / therapy*
Treatment Outcome