- Fluid choice continues to be mainly determined by clinician and regional preferences
- The choice of IV fluid affects patient outcome, with urgent need for further research into optimal fluid therapy
- CIT TAIT (‘sit tight’): Context, Indication, Targets, Timing, Amount of fluid, Infusion strategy, Type of fluid
In this section, we review the evidence and current recommendations for the use of IV fluids.
Sepsis and Septic Shock
- Hypoalbuminaemia is the most important prognostic factor in severe sepsis and septic shock
- Human albumin plus crystalloid is efficacious and safe in severe sepsis
- Recent research indicates that albumin, in addition to crystalloids, reduces mortality in both sepsis-2 and sepsis-3 categories
- HES is associated with increased mortality and AKI in critically ill patients. The EMA has issued strict new guidance due to the HES being given wrongly to critically ill patients and those with sepsis
- Volume replacement after large-volume paracentesis is recommended by clinical guidelines, to prevent post-paracentesis circulatory dysfunction
- Albumin performs better than other volume expanders or vasoconstrictors
European Association for the Study of the Liver (EASL) clinical practice guidelines on the management of decompensated cirrhosis, including ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome in cirrhosis are available (European Association for the Study of the Liver, 2018).
- Both pre- and postoperative hypoalbuminaemia are associated with adverse outcomes, such as increased incidence of AKI in children and an increased mortality
- Albumin is 5 times more effective than saline as plasma volume
- Albumin versus HES reduced mortality after CABG
- Discontinuation of HES in one Canadian institution led to a shorter hospital stay and reduced risk of red blood cell, plasma and platelet transfusion
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