Semin Respir Crit Care Med 2004; 25(6): 683-693
DOI: 10.1055/s-2004-860982
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Fluid Management in Shock

Greg S. Martin1 , Charmaine A. Lewis1
  • 1Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Further Information

Publication History

Publication Date:
22 December 2004 (online)

ABSTRACT

Shock is a broad category of injury to the human body caused by a variety of insults. Fluid resuscitation is the cornerstone of initial therapy for nearly all forms of shock. This article reviews the basic physiology determining body fluid composition, the goals of fluid resuscitation in shock, the types of fluids available for use, and clinical evidence for use of specific fluids based on etiology of the insult.

REFERENCES

  • 1 Starling E H. On the absorption of fluid from connective tissue spaces.  J Physiol. 1896;  19 312-326
  • 2 Kramer G C, Harms B A, Bodai B I, Renkin E M, Demling R H. Effects of hypoproteinemia and increased vascular pressure on lung fluid balance in sheep.  J Appl Physiol. 1983;  55 1514-1522
  • 3 Rackow E C, Weil M H, Macneil A R, Makabali C G, Michaels S. Effects of crystalloid and colloid fluids on extravascular lung water in hypoproteinemic dogs.  J Appl Physiol. 1987;  62 2421-2425
  • 4 Guyton A C, Lindsey A W. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema.  Circ Res. 1959;  7 649-657
  • 5 Rackow E C, Fein I A, Siegel J. The relationship of colloid oncotic pressure-pulmonary artery wedge pressure gradient to pulmonary edema and mortality in critically ill patients.  Chest. 1982;  82 433-437
  • 6 de Carvalho H, Matos J A, Bouskela E, Svensjo E. Vascular permeability increase and plasma volume loss induced by endotoxin was attenuated by hypertonic saline with or without dextran.  Shock. 1999;  12 75-80
  • 7 Pascual J MS, Watson J C, Runyon A E, Wade C E, Kramer G C. Resuscitation of intraoperative hypovolemia: a comparison of normal saline and hyperosmotic/hyperoncotic solutions in swine.  Crit Care Med. 1992;  20 200-210
  • 8 Vassar M J, Perry C A, Holcroft J W. Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock.  Arch Surg. 1990;  125 1309-1315
  • 9 Kreimeier U, Messmer K. Small-volume resuscitation: from experimental evidence to clinical routine: advantages and disadvantages of hypertonic solutions.  Acta Anaesthesiol Scand. 2002;  46 625-638
  • 10 Shoemaker W C, Schluchter M, Hopkins J A, Appel P L, Schwartz S, Chang P C. Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation.  Am J Surg. 1981;  142 73-84
  • 11 Wareing T H, Gruber M A, Brigham K L, Hammon Jr J W. Increased plasma oncotic pressure inhibits pulmonary fluid transport when pulmonary pressures are elevated.  J Surg Res. 1989;  46 29-34
  • 12 Goldwasser P, Feldman J. Association of serum albumin and mortality risk.  J Clin Epidemiol. 1997;  50 693-703
  • 12a Finfer S, Bellomo R, Boyce N et al.. A comparison of albumin and saline for fluid resuscitation in the intensive care unit.  N Engl J Med. 2004;  350 2247-2256
  • 13 Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies in intensive care units: results from a postal survey.  Intensive Care Med. 1998;  24 147-151
  • 14 Kapiotis S, Quehenberger P, Eichler H G et al.. Effect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin.  Crit Care Med. 1994;  22 606-612
  • 15 Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes.  Lancet. 1977;  1 466-469
  • 16 Weiskopf R B, Viele M K, Feiner J et al.. Human cardiovascular and metabolic response to acute, severe isovolemic anemia.  JAMA. 1998;  279 217-221
  • 17 Neilipovitz D, Hébert P C. Blood transfusion and sepsis. In Vincent JL, Carlet J, Opal SM The Sepsis Text Boston; Kluwer Academic Publishers 2002: 401-419
  • 18 Bordin J O, Heddle N M, Blajchman M A. Biologic effects of leukocytes present in transfused cellular blood products.  Blood. 1994;  84 1703-1721
  • 19 van de Watering L MG, Hermans J, Houbiers J GA et al.. Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial.  Circulation. 1998;  97 562-568
  • 20 Langenfield J E, Livingston D H, Macheido G W. Red cell deformability is an early indicator of infection.  Surgery. 1991;  110 398-404
  • 21 Baker C H, Wilmoth F R, Sutton E T. Reduced RBC versus plasma microvascular flow due to endotoxin.  Circ Shock. 1986;  20 127-139
  • 22 Hébert P C, Wells G W, Blajchman M A et al.. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care.  N Engl J Med. 1999;  340 409-417
  • 23 Hebert P C, Yetisir E, Martin C et al.. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?.  Crit Care Med. 2001;  29 227-234
  • 24 Wu W C, Rathore S S, Wang Y, Radford M J, Krumholz H M. Blood transfusion in elderly patients with acute myocardial infarction.  N Engl J Med. 2001;  345 1230-1236
  • 25 Corwin H L, Gettinger A, Pearl R G et al.. Efficacy of recombinant human erythropoietin in critically ill patients: a randomized controlled trial.  JAMA. 2002;  288 2827-2835
  • 26 Velanovich V. Crystalloid versus colloid fluid resuscitation: a meta-analysis of mortality.  Surgery. 1989;  105 65-71
  • 27 Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomized trials.  BMJ. 1998;  316 961-964
  • 28 Cochrane Injuries Group Albumin Reviewers . Human albumin administration in critically ill patients: systematic review of randomized controlled trials.  BMJ. 1998;  317 235-240
  • 29 Choi P T, Yip G, Quinonez L G, Cook D J. Crystalloids vs. colloids in fluid resuscitation: a systematic review.  Crit Care Med. 1999;  27 200-210
  • 30 Wilkes M M, Navickis R J. Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials.  Ann Intern Med. 2001;  135 149-164
  • 31 Allison S P, Lobo D N. Debate: albumin administration should not be avoided.  Crit Care. 2000;  4 147-150
  • 32 Webb A R. Crystalloid or colloid for resuscitation: are we any the wiser?.  Crit Care. 1999;  3 R25-R28
  • 33 Bernard G R, Sopko G, Cerra F et al.. Pulmonary artery catheterization and clinical outcomes.  JAMA. 2000;  283 2568-2572
  • 34 Connors Jr A F, Speroff T, Dawson N V et al.. The effectiveness of right heart catheterization in the initial care of critically ill patients.  JAMA. 1996;  276 889-897
  • 35 Hotchkiss R S, Karl I E. The pathophysiology and treatment of sepsis.  N Engl J Med. 2003;  348 138-150
  • 36 Yu D T, Platt R, Lanken P N et al.. Relationship of pulmonary artery catheter use to mortality and resource utilization in patients with severe sepsis.  Crit Care Med. 2003;  31 2734-2741
  • 37 Richard C, Warszawski J, Anguel N et al.. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome.  JAMA. 2003;  290 2713-2720
  • 38 Rivers E, Nguyed B, Havstad S et al.. Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001;  345 1368-1377
  • 39 Ernest D, Belzberg A S, Dodek P M. Distribution of normal saline and 5% albumin infusions in septic patients.  Crit Care Med. 1999;  27 46-50
  • 40 Rasmussen I, Arvidsson D, Zak A, Haglund U. Splanchnic and total body oxygen consumption in experimental fecal peritonitis in pigs: effects of dextran and iloprost.  Circ Shock. 1992;  36 299-306
  • 41 Kellum J A. Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: improved short-term survival and acid-base balance with Hextend compared with saline.  Crit Care Med. 2002;  30 300-305
  • 42 Schertel E R, Allen D A, Muir W W, Hansen B D. Evaluation of a hypertonic sodium chloride/dextran solution for treatment of traumatic shock in dogs.  J Am Vet Med Assoc. 1996;  208 366-370
  • 43 Marx G, Cobas M M, Schuerholz T et al.. Hydroxyethyl starch and modified fluid gelatin maintain plasma volume in a porcine model of septic shock with capillary leakage.  Intensive Care Med. 2002;  28 629-635
  • 44 Zhang H, Voglis S, Kim C H, Slutsky A S. Effects of albumin and Ringer's lactate on production of lung cytokines and hydrogen peroxide after resuscitated hemorrhage and endotoxemia in rats.  Crit Care Med. 2003;  31 1515-1522
  • 45 Walley K R, McDonald T E, Wang Y, Dai S, Russell J A. Albumin resuscitation increases cardiomyocyte contractility and decreases nitric oxide synthase II expression in rat endotoxemia.  Crit Care Med. 2003;  31 187-194
  • 46 Quinlan G J, Margarson M P, Mumby S, Evans T W, Gutteridge J M. Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion.  Clin Sci (Lond). 1998;  95 459-465
  • 47 Morisaki H, Bloos F, Keys J, Martin C, Neal A, Sibbald W J. Compared with crystalloid, colloid therapy slows progression of extrapulmonary tissue injury in septic sheep.  J Appl Physiol. 1994;  77 1507-1518
  • 48 Lum H, Siflinger-Birnboim A, Blumenstock F et al.. Serum albumin decreases transendothelial permeability to macromolecules.  Microvasc Res. 1991;  42 91-102
  • 49 Margarson M P, Soni N C. Effects of albumin supplementation on microvascular permeability in septic patients.  J Appl Physiol. 2002;  92 2139-2145
  • 50 Zikria B A, King T C, Stanford J. A biophysical approach to capillary permeability.  Surgery. 1989;  105 625-631
  • 51 Schortgen F, Lacherade J C, Bruneel F et al.. Effects of hydroxyethyl starch and gelatin on renal function in severe sepsis: a multicentre randomized study.  Lancet. 2001;  357 911-916
  • 52 Cittanova M L, Leblanc I, Legendre C, Mouquet C, Riou C, Coriat P. Effect of hydroxyethylstarch in brain-dead kidney donors of renal function in kidney-transplant recipients.  Lancet. 1996;  348 1620-1622
  • 53 Falk J L, Rackow E C, Astiz M E, Weil M H. Effects of hetastarch and albumin on coagulation in patients with septic shock.  J Clin Pharmacol. 1988;  28 412-415
  • 54 Damon L, Adams M, Stricker R B, Ries C. Intracranial bleeding during treatment with hydroxyethyl starch.  N Engl J Med. 1987;  317 964-965
  • 55 Yan S B, Helterbrand J D, Hartman D L, Wright T J, Bernard G R. Low levels of protein C are associated with poor outcome in severe sepsis.  Chest. 2001;  120 915-922
  • 56 Rackow E C, Falk J L, Fein I A et al.. Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock.  Crit Care Med. 1983;  11 839-850
  • 57 Haupt M T, Rackow E C. Colloid osmotic pressure and fluid resuscitation with hetastarch, albumin, and saline solutions.  Crit Care Med. 1982;  10 159-162
  • 58 Rackow E C, Mecher C, Astiz M E, Griffel M, Falk J L, Weil M H. Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion.  Crit Care Med. 1989;  17 394-398
  • 59 Weil M H, Henning R J, Morissette M, Michaels S. Relationship between colloid osmotic pressure and pulmonary artery wedge pressure in patients with acute cardiorespiratory failure.  Am J Med. 1978;  64 643-650
  • 60 Rackow E C, Fein I A, Leppo J. Colloid osmotic pressure as a prognostic indicator of pulmonary edema and mortality in the critically ill.  Chest. 1977;  72 709-713
  • 61 Kohler J P, Rice C L, Zarins C K, Cammack III B F, Moss G S. Does reduced colloid oncotic pressure increase pulmonary dysfunction in sepsis?.  Crit Care Med. 1981;  9 90-93
  • 62 Mangialardi R J, Martin G S, Bernard G R et al.. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis.  Crit Care Med. 2000;  28 3137-3145
  • 63 Haupt M T, Teerapong P, Green D, Schaeffer Jr R C, Carlson R W. Increased pulmonary edema with crystalloid compared to colloid resuscitation of shock associated with increased vascular permeability.  Circ Shock. 1984;  12 213-224
  • 64 Sibbald W J, Driedger A A, Wells G A, Myers M L, Lefcoe M. The short-term effects of increasing plasma colloid osmotic pressure in patients with noncardiac pulmonary edema.  Surgery. 1983;  93 620-633
  • 65 Virgilio R W, Metildi L A, Peters R M, Shackford S R. Colloid vs. crystalloid volume resuscitation of patients with severe pulmonary insufficiency.  Surg Forum. 1979;  30 166-168
  • 66 Metildi L A, Shackford S R, Virgilio R W, Peters R M. Crystalloid versus colloid in fluid resuscitation of patients with severe pulmonary insufficiency.  Surg Gynecol Obstet. 1984;  158 207-212
  • 67 Martin G S, Mangialardi R J, Wheeler A P et al.. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury.  Crit Care Med. 2002;  30 2175-2182
  • 68 Skillman J J, Parikh B M, Tanenbaum B J. Pulmonary arteriovenous admixture: improvement with albumin and diuresis.  Am J Surg. 1970;  119 440-447
  • 69 Bickell W H, Wall M J, Pepe P E et al.. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.  N Engl J Med. 1994;  331 1105-1109
  • 69a Turner J, Nicholl J, Cox H, Dixon S, Yates D. A randomised controlled trial of prehospital intravenous fluid replacement therapy in serious trauma.  Health Technol Assess. 2000;  4 1-157
  • 70 Kwan I, Bunn R, Roberts I. Timing and volume of fluid administration for patients with bleeding.  Cochrane Database Syst Rev. 2004;  3 DC002245
  • 71 Pascual J L, Ferri L E, Chaudhury P et al.. Hemorrhagic shock resuscitation with a low molecular weight starch reduces neutrophil-endothelial interactions and vessel leakage in vivo.  Surg Infect (Larchmt). 2001;  2 275-287
  • 72 Horstick G, Lauterbach M, Kempf T et al.. Early albumin infusion improves global and local hemodynamics and reduces inflammatory response in hemorrhagic shock.  Crit Care Med. 2002;  30 851-855
  • 73 Boura C, Caron A, Longrois D, Mertes P M, Labrude P, Menu P. Volume expansion with modified hemoglobin solution, colloids, or crystalloid after hemorrhagic shock in rabbits: effects in skeletal muscle oxygen pressure and use versus arterial blood velocity and resistance.  Shock. 2003;  19 176-182
  • 74 Sun L L, Ruff P, Austin B et al.. Early up-regulation of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 expression in rats with hemorrhagic shock and resuscitation.  Shock. 1999;  11 416-422
  • 75 Deb S, Martin B, Sun L et al.. Resuscitation with lactated Ringer's solution in rats with hemorrhagic shock induces immediate apoptosis.  J Trauma. 1999;  46 582-588
  • 76 Rhee P, Wang D, Ruff P et al.. Human neutrophil activation and increased adhesion by various resuscitation fluids.  Crit Care Med. 2000;  28 74-78
  • 77 Deb S, Sun L, Martin B et al.. Lactated Ringer's solution and hetastarch but not plasma resuscitation after rat hemorrhagic shock is associated with immediate lung apoptosis by the up-regulation of the Bax protein.  J Trauma. 2000;  49 47-53
  • 78 Rizoli S B. Crystalloids and colloids in trauma resuscitation: a brief overview of the current debate.  J Trauma. 2003;  54(5 Suppl) S82-S88
  • 79 Modig J. Advantages of dextran 70 over Ringer acetate solution in shock treatment and in prevention of adult respiratory distress syndrome: a randomized study in man after traumatic-hemorrhagic shock.  Resuscitation. 1983;  10 219-226
  • 80 Lowe R J, Moss G S, Jilek J, Levine H D. Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man.  Surgery. 1977;  81 676-683
  • 81 Weaver D W, Ledgerwood A M, Lucas C E, Higgins R, Bouwman D L, Johnson S D. Pulmonary effects of albumin resuscitation for severe hypovolemic shock.  Arch Surg. 1978;  113 387-392
  • 82 Hauser C J, Shoemaker W C, Turpin I, Goldberg S J. Oxygen transport responses to colloids and crystalloids in critically ill surgical patients.  Surg Gynecol Obstet. 1980;  150 811-816
  • 83 Mattox K L, Maningas P A, Moore E E et al.. Prehospital hypertonic saline/dextran infusion for posttraumatic hypotension.  Ann Surg. 1991;  213 482-491
  • 84 Wade C E, Grady J J, Kramer G C. Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma.  J Trauma. 2003;  54(5 Suppl) S144-S148
  • 85 Wade C E, Kramer G C, Grady J J, Fabian T C, Younes R N. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies.  Surgery. 1997;  122 609-616
  • 86 Sakaki M, Iwao T, Oho K, Toyonaga A, Tanikawa K. Prognostic factors in cirrhotic patients receiving long-term sclerotherapy for the first bleeding from oesophageal varices.  Eur J Gastroenterol Hepatol. 1998;  10 21-26
  • 87 Lee H, Hawker F H, Selby W, McWilliam D B, Herkes R G. Intensive care treatment of patients with bleeding esophageal varices: results, predictors of mortality, and predictors of the adult respiratory distress syndrome.  Crit Care Med. 1992;  20 1555-1563
  • 88 Jardin F, Prost J F, Ozier Y, Margairaz A. Hemodialysis in septic patients: improvements in tolerance of fluid removal with concentrated albumin as the priming fluid.  Crit Care Med. 1982;  10 650-652
  • 89 Van der Sande F M, Kooman J P, Barendregt J N, Nieman F H, Leunissen K M. Effect of intravenous saline, albumin, or hydroxyethylstarch on blood volume during combined ultrafiltration and hemodialysis.  J Am Soc Nephrol. 1999;  10 1303-1308
  • 90 Van der Sande F M, Luik A J, Kooman J P, Verstappen V, Leunissen K M. Effect of intravenous fluids on blood pressure course during hemodialysis in hypotensive-prone patients.  J Am Soc Nephrol. 2000;  11 550-555
  • 91 Anonymous . The diagnosis and management of anaphylaxis, III: Algorithm for the treatment of acute anaphylaxis.  J Allergy Clin Immunol. 1998;  101 S469-S471
  • 92 Fisher M M. Clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse.  Anaesth Intensive Care. 1986;  14 17-21
  • 93 Luz da P L, Shubin H, Weil M H, Jacobson E, Stein L. Pulmonary edema related to changes in colloid osmotic and pulmonary artery wedge pressure in patients after acute myocardial infarction.  Circulation. 1975;  51 350-357

Greg S MartinM.D. M.Sc. 

Pulmonary, Allergy, and Critical Care, Emory University School of Medicine

69 Jesse Hill Jr Dr. SE, Rm. 2D-004

Atlanta, GA 30303

Email: Greg_Martin@emory.org

    >