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Choice of resuscitation fluid 

Choice of resuscitation fluid
Chapter:
Choice of resuscitation fluid
Author(s):

John Myburgh

and Naomi E. Hammond

DOI:
10.1093/med/9780199600830.003.0069
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date: 03 December 2020

Fluid resuscitation is a ubiquitous intervention in critically-ill patients. There is wide variation in practice and emerging evidence that the choice of resuscitation fluid may affect outcome in selected patient populations. It is likely that beneficial or adverse effects relate not only to the physicochemical properties of the fluid but also to the volume (dose) and rate of administration. Interstitial oedema is a common side-effect associated with all fluids and its development is associated with organ dysfunction. Crystalloids should be first-choice resuscitation fluids for almost all patients, with evidence that balanced salt solutions confer any benefit over saline being limited to observational data. Consideration of serum sodium (or osmolality), pH, renal function and coagulation status may affect selection of a specific crystalloid solution. On the balance of evidence, colloids do not confer any clinical advantage over crystalloids and they should be used with caution, if at all. Albumin is contraindicated for the resuscitation of patients with severe traumatic brain injury. Hydroxyethyl starch is associated with increased risk of death and acute kidney injury in critically-ill patients, particularly those with severe sepsis and septic shock. Current evidence does not support the use of other semi-synthetic colloids for resuscitation.

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