TY  - JOUR
A1  - Haren, Frank van
A1  - Zacharowski, Kai
T1  - What's new in volume therapy in the intensive care unit?
T2  - Best practice & research. Clinical anaesthesiology
N2  - The administration of intravenous fluid to critically ill patients is one of the most common but also one of the most fiercely debated interventions in intensive care medicine. During the past decade, a number of important studies have been published which provide clinicians with improved knowledge regarding the timing, the type and the amount of fluid they should give to their critically ill patients. However, despite the fact that many thousands of patients have been enrolled in these trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Early adequate resuscitation of patients in shock followed by a restrictive strategy may be associated with better outcomes. Colloids such as modern hydroxyethyl starch are more effective than crystalloids in early resuscitation of patients in shock, and are safe when administered during surgery. However, these colloids may not be beneficial later in the course of intensive care treatment and should best be avoided in intensive care patients who have a high risk of developing acute kidney injury. Albumin has no clear benefit over saline and is associated with increased mortality in neurotrauma patients. Balanced fluids reduce the risk of hyperchloraemic acidosis and possibly kidney injury. The use of hypertonic fluids in patients with sepsis and acute lung injury warrants further investigation and should be considered experimental at this stage. Fluid therapy impacts relevant patient-related outcomes. Clinicians should adopt an individualized strategy based on the clinical scenario and best available evidence. One size does not fit all.
KW  - fluid
KW  - intensive care
KW  - colloid
KW  - crystalloid
KW  - albumin
KW  - hypertonic
KW  - resuscitation
KW  - shock
Y1  - 2014
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/32400
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-324007
SN  - 1521-6896
N1  - This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
VL  - 28
IS  - 3
SP  - 275
EP  - 283
PB  - Elsevier
CY  - Amsterdam [u.a.]
ER  -