Fluid challenge revisited

Objective: To discuss the rationale, technique, and clinical application of the fluid challenge. Data Source: Relevant literature from MEDLINE and authors’ personal databases. Study Selection: Studies on fluid challenge in the acutely ill. Data Extraction: Based largely on clinical experience and assessment of the relevant published literature, we propose that the protocol should include four variables, namely 1) the type of fluid administered, 2) the rate of fluid administration, 3) the critical end points, and 4) the safety limits. Conclusions: A protocol for routine fluid challenge is proposed with defined rules and based on the patient’s response to the volumes infused. The technique allows for prompt correction of fluid deficits yet minimizes the risks of fluid overload. LEARNING OBJECTIVES On completion of this article, the reader should be able to: Explain the signs of hypovolemia. Describe how to administer a fluid challenge. Use this information in a clinical setting. Both authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity. Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.