Fluid Resuscitation Strategies in Septic Patients

Sepsis remains a leading cause of critical illness worldwide, characterised by a dysregulated host response to infection that may progress to life-threatening organ dysfunction. Fluid resuscitation is a foundational intervention aimed at restoring intravascular volume, improving tissue perfusion and supporting cardiac output in patients with sepsis and septic shock. Strategies have evolved from rigid protocols favouring large crystalloid boluses towards more nuanced approaches that balance the benefits of early circulatory support against the risks of fluid overload, such as pulmonary oedema and impaired organ function. Contemporary practice emphasises individualisation of therapy, guided by repeated assessment of fluid responsiveness, dynamic haemodynamic indices and markers of end-organ perfusion. Integration of vasopressor support, typically noradrenaline, is recommended when volume alone fails to maintain adequate mean arterial pressure. Emerging evidence suggests that both the timing and rate of fluid administration, as well as the choice between crystalloids, colloids and adjunct albumin, influence outcomes. Globally, resource availability and patient characteristics further shape resuscitation protocols, underlining the need for strategies that are both evidence based and adaptable to diverse care settings.

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Fluid Resuscitation Strategies in Septic Patients publication trend

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

Technical terms

Septic shock: A subset of sepsis in which profound circulatory, cellular and metabolic abnormalities substantially increase mortality risk.

Fluid responsiveness: The capacity of the heart to increase stroke volume in response to a fluid bolus, commonly assessed using dynamic measurements of preload or cardiac output.

Crystalloids: Aqueous solutions of mineral salts or other water-soluble molecules used for intravascular volume expansion (e.g. saline, Ringer’s lactate).

Colloids: Fluids containing larger molecules (e.g. albumin, starches) intended to remain longer in the intravascular compartment and support oncotic pressure.

Vasopressors: Pharmacological agents (such as noradrenaline) that constrict blood vessels to raise arterial pressure and maintain organ perfusion when fluids alone are insufficient.

References

1. Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis: a propensity score-matched cohort study. Annals of Intensive Care (2023).
2. Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database. Annals of Intensive Care (2021).
3. Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study. Critical Care (2020).