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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2018 Feb 14

DOI: 10.23736/S0375-9393.18.12422-9


lingua: Inglese

Fluid resuscitation during early sepsis: a need for individualization

Mathieu JOZWIAK 1, 2, Olfa HAMZAOUI 3, Xavier MONNET 1, 2, Jean-Louis TEBOUL 1, 2

1 Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, APHP, Service De Réanimation Médicale, Le Kremlin-Bicêtre, France; 2 Inserm UMR S_999, Université Paris-Sud, Le Kremlin-Bicêtre, France; 3 Hôpitaux Universitaires Paris-Sud, Hôpital Béclère, APHP, Service De Réanimation Médicale, Clamart, France


The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called “early goal-directed therapy” (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. Indeed, recent multicenter randomized clinical trials showed no reduction in all-cause mortality, duration of organ support and in-hospital length of stay with EGDT in comparison with standard care. The most recent SCC guidelines have dropped the original EGDT by deleting the central venous pressure and the central venous oxygen saturation from the recommendations. Dynamic variables of fluid responsiveness are now recommended to be used after an initial fluid infusion of a fixed volume (30 mL/kg) during the first three hours of resuscitation. However, this approach is also questionable due to the lack of individualization at the early and crucial phase of resuscitation. In this review, we propose a more personalized approach for the early and later phases of fluid resuscitation during sepsis.

KEY WORDS: Fluid administration - Fluid overload - Fluid responsiveness - Sepsis - Septic shock

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Publication History

Article first published online: February 14, 2018
Manuscript accepted: February 13, 2018
Manuscript revised: January 17, 2018
Manuscript received: September 13, 2017

Per citare questo articolo

Jozwiak M, Hamzaouiì O, Monnet X, Teboul JL. Fluid resuscitation during early sepsis: a need for individualization. Minerva Anestesiol 2018 Feb 14. DOI: 10.23736/S0375-9393.18.12422-9

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