ABSTRACT
Sepsis is a systemic inflammatory response syndrome (SIRS) associated with an infection. It is currently the 13th leading cause of death in the United States, and despite advances in modern medicine, the mortality from sepsis has not changed (1). Patients may present with tachycardia, tachypnea, fever, and leukocytosis, or may be in shock with multiple organ failure. Like SIRS, the release of systemic inflammatory mediators in sepsis results in perturbations in the microcirculation, venodilation, and renal and myocardial dysfunction. Fluid therapy is necessary in the treatment of sepsis because of the relative hypovolemia and continued extravasation of fluid from the vascular compartment. The goal of fluid resuscitation in sepsis is to restore arterial and filling pressures to improve end-organ perfusion and oxidative metabolism, while minimizing excessive overhydration, which can lead to pulmonary edema, paralytic ileus, and compartment syndromes. To attain this goal, physicians use several different indices to guide fluid and other therapies. Intensive efforts are made to avoid overhydration. However, to maintain intravascular hydration, fluid therapy in sepsis, nonetheless, results in a large positive fluid balance. Although necessary, fluid therapy alone is rarely enough to maintain physiologic homeostasis, and adjunctive therapies such as pressors or even inotropes are often needed.
