Fluid management in sepsis: 5 reasons why less fluid might be more rational

The main physiological reason for fluid administration during hemodynamic resuscitation is not to increase blood pressure (BP) or to compensate for fluid loss. Fluid administration is all about enhancing cardiac output (CO), according to the Frank–Starling law. (1) It is expected that during shock states, this improvement in CO might increase oxygen delivery, peripheral perfusion and, hopefully, survival. A landmark single-center trial was published by Rivers et al. in 2001 and reported a 16% absolute mortality reduction in septic patients with a hemodynamic resuscitation bundle guided by central venous saturation (early goal-directed therapy). (2) Although this protocol was associated with approximately 13L of fluid administration in the first 72 hours after enrollment, (2) the astonishing mortality reduction promoted its worldwide adoption (the “early goal era”).