Fluid resuscitation in septic shock too much, too little or just right.docVIP

Prowle Critical Care 2012, 16:436 /content/16/3/436 LET TER Fluid resuscitation in septic shock: too much, too little or just right? John R Prowle* See related research by Smith and Perner, /content/16/3/R76 In their interesting observational study Smith and Perner lowest quartile, associated with the best prognosis, in the us, I do not believe that [1] describe ? uid resuscitation (FR) in 164 patients with VASST study (16 L at 96 septic shock, concluding that survival was better in the bene? t of higher-volume FR described is in con? ict patients receiving higher volumes over the ? rst 72 h. I with the harm associated with larger volumes reported think we should be cautious, however, to conclude from this that more is better. previously [2]. Similarly, median FR in the lower-volume group was only 4.3 L in 72 h. As FR was physician- directed, lower-volume FR might have been indicated by factors like chronic cardiac failure or ? uid unresponsive- ness associated with poorer outcomes irrespective of FR; no evidence is provided to conclude that increasing FR in this group would have improved survival. Median FR was 4.0 L over 24 h, and 7.5 L by 72 h - relatively small volumes for patients with ongoing shock. FR volumes reported from trials performed in septic shock are substantially larger despite comparable illness severity; mean FR over 72 h was approximately 19 L in the Vasopressin in Septic Shock Trial (VASST) study [2], Overall, this report records excellent outcomes using 13 L in the study by Rivers and colleagues [3] and 16 L in moderate FR by recent standards. Further trials are another recent study [4]. Indeed, median FR in the high- volume group (10.9 L at 72 h) was comparable to the needed to characterize the dose and indications for FR in septic shock. Authors’ response Anders Perner and S?ren H Smith anks to Dr Prowle