Importance of intravenous fluid dose and composition in surgical ICU patients
Author Department
Anesthesiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
8-1-2012
Abstract
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'.
Publication ISSN
0195-9131
Recommended Citation
Raghunathan K, McGee WT, Higgins T. Importance of intravenous fluid dose and composition in surgical ICU patients Curr Opin Crit Care 2012 Aug;18(4):350-7.
PMID
22732434