Fluid Management in Shock

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.

Heterogeneity and Oxidation Status of Commercial Human Albumin Preparations in Clinical Use

“…We have shown that albumin levels in BAL were extremely high in the early phase of ARDS in comparison with control ventilated patients, and they remained significantly high in the intermediate and late phase in ARDS patients (2). The balance between hydrostatic, osmotic, and surface tension pressures is continuously changing and difficult to control.…”

“…Chan et al (2) studied NTD in HSA and albumin from other species and found that it is a sequence (species)-, temperature-, and time-dependent phenomenon and proposed a mechanism. Chan et al (2) studied NTD in HSA and albumin from other species and found that it is a sequence (species)-, temperature-, and time-dependent phenomenon and proposed a mechanism.…”

“…Additionally, the authors have chosen a methodology different from that of Chan et al (2) for calculating the percentage of NTD (%NTD). We have observed zero NTD with newly manufactured recombinant albumin, whilst purchased HSA has been through a viral inactivation step (60°C for 10 hrs), which causes some NTD even before the start of the shelf life.…”

“…The timing of these therapies in ALI/ ARDS is uncertain because the frequent early occurrence of hemodynamic instability makes diuretic therapy infeasible (2). In addition, the earliest phases of ALI/ARDS are associated with the greatest abnormalities in capillary permeability, reducing the ability to establish an oncotic pressure gradient and potentiating the possibility of colloids leaking to the interstitial space and worsening pulmonary edema (3) (a common theoretical concern, despite clinical evidence to the contrary) (4).…”

The Role for Invasive Monitoring in Acute Lung Injury

“…1 Because ALI results from diverse clinical insults, the management in the pre-ALI phase will appropriately differ between patients. For purposes of this review, because sepsis is the most common cause of ALI, I have selected septic shock as the prototypical “at risk” disease paradigm requiring invasive monitoring and management.…”