Resuscitation fluid therapy - a systematic review of principles and cross-sectional study of clinical practice

Abstract

Abstract Resuscitation fluid therapy -a systematic review of principles and cross-sectional study of clinical practice Degreee Projekt thesis, Programme in Medicine; Daniel Olsson & Sophie Lindgren, supervisor - Institute of Clinical Sciences Programme in Medicine Gothenburg, Sweden 2015 Background: Saline solution has been used in fluid resuscitation since the 19th century. Different colloids have been used the last 60 years. Choice of resuscitation fluid has varied over the years and has been heavily influenced by local traditions and clinician’s preference. Method: This article consists of a systematic review and meta-analysis of current resuscitation fluid research combined with a survey at the Department of Anesthesia and Intensive Care at Sahlgrenska University Hospital backed with data of resuscitation fluid usage at Sahlgrenska University Hospital. Results: In patients with sepsis albumin has been shown to decrease mortality compared to saline solution and HES increases risk of renal replacement therapy and may increase mortality. In a perioperative setting such risks with HES has not been identified. In both ICU and perioperative environment balanced crystalloid seem superior to saline solution. Out of 62 respondents in our survey 56% and 69% answered that they used both crystalloids and colloids for perioperative and sepsis resuscitation respectively, and 74% that their first perioperative choice was HES. However, when treating septic shock, 89% answered that their preferred colloid was albumin. Conclusion: Balanced crystalloids have an important role in fluid resuscitation. Albumin is the preferred colloid in severe sepsis but in other scenarios HES may be considered. The anesthesiologists at the Department of Anesthesia and Intensive Care had a good adherence to current research although perioperative albumin use ought to be reconsidered due to high cost and lack of evidence.