Optimizing fluid therapy in shock

Curr Opin Crit Care. 2019 Jun;25(3):246-251. doi: 10.1097/MCC.0000000000000604.


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.

Publication types

  • Review

MeSH terms

  • Fluid Therapy*
  • Hemodynamics
  • Humans
  • Hypovolemia
  • Resuscitation
  • Shock* / therapy