Fluid Resuscitation Strategies in Critical Care Management

Fluid resuscitation remains a cornerstone of critical care, seeking to correct hypovolaemia, sustain organ perfusion and restore haemodynamic stability. Contemporary practice has shifted from indiscriminate large‐volume saline administration towards tailored regimens that account for fluid type, timing and patient physiology. Crystalloid solutions, including isotonic saline and balanced electrolyte preparations, are favoured for their affordability and safety, although concerns over hyperchloraemic acidosis have prompted adoption of buffered alternatives. Colloid fluids, notably human albumin and synthetic colloids, offer enhanced intravascular retention but carry specific risk–benefit profiles that continue to be debated. Modern frameworks embrace goal-directed therapy with dynamic indices of fluid responsiveness, early protocolised resuscitation bundles and a phased approach—resuscitation, optimisation, stabilisation and de-escalation—to minimise fluid overload and associated complications. Broadly, practice varies by region and patient subgroup, yet the global trend is towards evidence-based, personalised fluid stewardship that balances efficacy with safety.

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Fluid Resuscitation Strategies in Critical Care Management publication trend

The graph below shows the total number of articles in fluid resuscitation strategies in critical care management across all publications each year (not limited to Nature Index journals).

Technical terms

Crystalloids: Aqueous solutions of electrolytes (e.g. saline or balanced buffers) that distribute freely between intravascular and interstitial spaces.

Colloids: High-molecular-weight substances (natural or synthetic) that exert oncotic pressure to remain predominantly within the vascular compartment.

Balanced solution: Crystalloid fluids formulated to approximate plasma electrolyte composition and minimise acid–base disturbances.

Metabolic acidosis: Acid–base disorder characterised by primary reduction in bicarbonate concentration and pH below normal range.

Fluid responsiveness: Increase in stroke volume or cardiac output following a defined fluid bolus, used to guide resuscitation decisions.

References

1. Identification of indications for albumin administration in septic patients with liver cirrhosis. Critical Care (2023).
2. Clinical efficacy of sodium bicarbonate in treating pediatric metabolic acidosis with varying level of acid–base balance parameters: a real-world study. BMC Medicine (2023).
3. Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Annals of Intensive Care (2020).