Paul E Marik1, Maxwell Weinmann2. 1. Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk. 2. Director Acute Respiratory Intensive Care Unit, Emory University Hospital, Atlanta, USA.
Abstract
PURPOSE OF REVIEW: Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock. RECENT FINDINGS: Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality. SUMMARY: We believe that the approach to fluid therapy must be individualized based on the cause of shock as well as the patient's major diagnosis, comorbidities and hemodynamic and respiratory status. A conservative, physiologically guided approach to fluid resuscitation likely improves patient outcomes.
PURPOSE OF REVIEW: Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock. RECENT FINDINGS: Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality. SUMMARY: We believe that the approach to fluid therapy must be individualized based on the cause of shock as well as the patient's major diagnosis, comorbidities and hemodynamic and respiratory status. A conservative, physiologically guided approach to fluid resuscitation likely improves patient outcomes.
Authors: Raphael Romano Bruno; Bernhard Wernly; Behrooz Mamandipoor; Richard Rezar; Stephan Binnebössel; Philipp Heinrich Baldia; Georg Wolff; Malte Kelm; Bertrand Guidet; Dylan W De Lange; Daniel Dankl; Andreas Koköfer; Thomas Danninger; Wojciech Szczeklik; Sviri Sigal; Peter Vernon van Heerden; Michael Beil; Jesper Fjølner; Susannah Leaver; Hans Flaatten; Venet Osmani; Christian Jung Journal: Front Med (Lausanne) Date: 2021-07-09