Fluid choices impact outcome in septic shock

PURPOSE OF REVIEW: We discuss the goals of resuscitation, in both the early and the later phases, measures of organ perfusion, fluid responsiveness and the consequences of tissue edema. RECENT FINDINGS: The cost of over-aggressive fluid resuscitation is increased organ failure and mortality. In anticipation of the upcoming trials on early goal-directed therapy, we explore strategies to maximize effectiveness of resuscitation. Furthermore, we review recent data on the choice of fluid therapy. SUMMARY: Rapid diagnosis and early fluid resuscitation are crucial to patients with septic shock, initially with the primary goal to relieve the overt tissue hypoxia. Early fluid therapy is important with the caveat that patients must show an increase in their cardiac output. Beyond 6-12 h further positive fluid balance may not usefully improve tissue oxygenation and may be counterproductive.