Fluid therapy in critically ill adults with sepsis- Risks and benefits
USA: Fluids are one of the essential components in treating critically ill patients with sepsis. The latest review article published in the Journal of the American Medical Association (JAMA) on June 13, 2023 has pointed out how they should be administered in each phase of critical illness.
The researchers suggest "clinicians should consider the benefits and risks of fluid administration in each phase of critical illness, avoid hydroxyethyl starch use, and facilitate fluid removal for patients recovering from acute respiratory distress syndrome." They, however, add that optimal fluid management in sepsis patients remains uncertain.
- A phase 3, randomized clinical trials (RCTs) in which 3723 patients with sepsis who received 1 to 2 L of fluid reported that goal-directed therapy administering fluid boluses did not decrease mortality compared with unstructured clinical care (24.9% vs 25.4%).
- Another RCT reported that among 1554 patients in the intensive care unit with septic shock treated with at least 1 L of fluid compared with more liberal fluid administration, restricting fluid administration without severe hypoperfusion did not reduce mortality (42.3% vs 42.1%).
- An RCT of 1000 patients with acute respiratory distress with limited fluid administration and diuretics improved the number of days alive without mechanical ventilation compared with fluid treatment to attain higher intracardiac pressure (14.6 vs 12.1 days).
Based on these various research articles, it can be concluded that although fluid therapy is vital in treating patients who are critically ill with sepsis, it remains uncertain and does not improve mortality with fluid therapy
.Fernando G. Zampieri also noted that clinicians should consider the risks and benefits of fluid administration in each phase of critical illness and facilitate fluid removal for patients recovering from acute respiratory distress syndrome.
