Crystalloids for Fluid Resuscitation in Sepsis: Where Is the Balance?
Authors: R. Phillip Dellinger
Journal: Annals of Internal Medicine (2014)

Editorials2 September 2014Crystalloids for Fluid Resuscitation in Sepsis: Where Is the Balance?R. Phillip Dellinger, MD, MScR. Phillip Dellinger, MD, MScFrom Cooper Medical School of Rowan University and Adult Health Institute, Cooper University Health, Camden, New Jersey.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1565 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Optimal methods of fluid resuscitation for critically ill patients with sepsis are much debated. In this issue, Rochwerg and colleagues (1) report a sophisticated and stimulating systematic review and network meta-analysis of various methods of fluid resuscitation that informs this debate. They conclude that current evidence supports the possibility that starches may be associated with higher mortality than crystalloids (high confidence), albumin may be superior to saline (moderate confidence) and low-molecular-weight starch (low confidence), and balanced crystalloids may be superior to saline (moderate confidence). In this editorial, I focus on this last finding.Crystalloids are sodium-based electrolyte fluids that are ...References1. Rochwerg B, Alhazzani W, Sindi A, Heels-Ansdell D, Thabane L, Fox-Robichaud A, et al; Fluids in Sepsis and Septic Shock Group. Fluid resuscitation in sepsis. A systematic review and network meta-analysis. Ann Intern Med. 2014;161:347-55. doi:10.7326/M14-0178 LinkGoogle Scholar2. O'Shaughnessy WB. Proposal of a new method of treating the blue epidemic cholera by the injection of highly oxygenated salts into the venous system. Lancet. 1831;17:366-71. CrossrefGoogle Scholar3. Awad S, Allison SP, Lobo DN. The history of 0.9% saline. 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[PMID: 23073953] doi:10.1001/jama.2012.13356 CrossrefMedlineGoogle Scholar8. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al; Surviving Sepsis Campaign Management Guidelines Committee. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32:858-73. [PMID: 15090974] CrossrefMedlineGoogle Scholar9. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al; International Surviving Sepsis Campaign Guidelines Committee. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296-327. [PMID: 18158437] CrossrefMedlineGoogle Scholar10. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637. [PMID: 23353941] doi:10.1097/CCM.0b013e31827e83af CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: R. Phillip Dellinger, MD, MScAffiliations: From Cooper Medical School of Rowan University and Adult Health Institute, Cooper University Health, Camden, New Jersey.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1565.Corresponding Author: R. Phillip Dellinger, MD, MSc, Department of Medicine, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103; e-mail, dellinger-phil@cooperhealth.edu. This article was published online first at www.annals.org on 22 July 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFluid Resuscitation in Sepsis Bram Rochwerg , Waleed Alhazzani , Anees Sindi , Diane Heels-Ansdell , Lehana Thabane , Alison Fox-Robichaud , Lawrence Mbuagbaw , Wojciech Szczeklik , Fayez Alshamsi , Sultan Altayyar , Wang-Chun Ip , Guowei Li , Michael Wang , Anna Włudarczyk , Qi Zhou , Gordon H. Guyatt , Deborah J. Cook , Roman Jaeschke , and Djillali Annane , for the Fluids in Sepsis and Septic Shock Group Metrics Cited byFLUID trial: a protocol for a hospital-wide open-label cluster crossover pragmatic comparative effectiveness randomised pilot trialBalanced crystalloids versus saline in the intensive care unit: study protocol for a cluster-randomized, multiple-crossover trial 2 September 2014Volume 161, Issue 5Page: 372-373KeywordsChloridesHospital medicineLactatesNetwork analysisResuscitationSaline solutionsSepsisShockSodiumStarches ePublished: 2 September 2014 Issue Published: 2 September 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...