Dosing Fluids in Early Septic Shock

Chest. 2021 Apr;159(4):1493-1502. doi: 10.1016/j.chest.2020.09.269. Epub 2020 Oct 13.


Early IV fluid administration remains one of the modern pillars of sepsis treatment; however, questions regarding amount, type, rate, mechanism of action, and even the benefits of fluid remain unanswered. Administering the optimal fluid volume is important, because overzealous fluid resuscitation can precipitate multiorgan failure, prolong mechanical ventilation, and worsen patient outcomes. After the initial resuscitation, further fluid administration should be determined by individual patient factors and measures of fluid responsiveness. This review describes various static and dynamic measures that are used to assess fluid responsiveness and summarizes the evidence addressing these metrics. Subsequently, we outline a practical approach to the evaluation of fluid responsiveness in early septic shock and explore further areas crucial to ongoing research examining this topic.

Keywords: critical care echocardiography; fluid management; sepsis; volume responsive.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Echocardiography
  • Fluid Therapy / methods*
  • Humans
  • Monitoring, Physiologic
  • Prognosis
  • Shock, Septic / therapy*