Fluid therapy in resuscitated sepsis: less is more

Chest. 2008 Jan;133(1):252-63. doi: 10.1378/chest.07-1496.


Fluid infusion may be lifesaving in patients with severe sepsis, especially in the earliest phases of treatment. Following initial resuscitation, however, fluid boluses often fail to augment perfusion and may be harmful. In this review, we seek to compare and contrast the impact of fluids in early and later sepsis; show that much fluid therapy is clinically ineffective in patients with severe sepsis; explore the detrimental aspects of excessive volume infusion; examine how clinicians assess the intravascular volume state; appraise the potential for dynamic indexes to predict fluid responsiveness; and recommend a clinical approach.

Publication types

  • Review

MeSH terms

  • Blood Pressure
  • Critical Care
  • Critical Illness / therapy
  • Fluid Therapy / adverse effects
  • Fluid Therapy / methods*
  • Hemodynamics
  • Humans
  • Practice Guidelines as Topic
  • Resuscitation*
  • Sepsis / physiopathology
  • Sepsis / therapy*
  • Severity of Illness Index
  • Stroke Volume