Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently
edema. Fluid
resuscitation is a mainstay in the initial treatment of
sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing
edema; unfortunately,
edema and
edema-related complications are common consequences of current
resuscitation strategies. Crystalloids are recommended as first-line
therapy, but the type of
crystalloid is not specified. There is increasing evidence that
normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative.
Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the
critically ill and are no longer indicated in these patients. In the
trauma population, the shift to plasma-based
resuscitation with decreased use of
crystalloid and
colloid in the treatment of
hemorrhagic shock has led to decreased inflammatory and
edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar
resuscitation strategy in the setting of
sepsis.