Cardiovascular systemThe influence of volume management on outcomeBagshaw, Sean Ma; Bellomo, Rinaldob Author Information aDivision of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada bDepartment of Intensive Care, Austin Hospital, Melbourne, Australia Correspondence to Professor Rinaldo Bellomo MD, FRACP, FJFICM, Director of Intensive Care Research, Department of Intensive Care, Austin Hospital, Heidelberg, Victoria 3084, Australia Tel: +61 3 9496 5992; fax: +61 3 9496 3932; e-mail: [email protected] Current Opinion in Critical Care: October 2007 - Volume 13 - Issue 5 - p 541-548 doi: 10.1097/MCC.0b013e3282e2a978 Buy Metrics Abstract Purpose of review Fluid (volume) therapy is an integral component in the management of critically ill patients and fluid management may influence outcome. There is much controversy, however, about the type, timing and amount of fluid therapy. Here, we discuss the evidence available to guide such choices. Recent findings Fluid therapy is widely endorsed for resuscitation of critically ill patients across a range of conditions. Yet, the approach to fluid therapy is subject to substantial variation in clinical practice. Emerging data show that the choice, timing and amount of fluid therapy may affect clinical outcomes. Synthetic colloids may increase the risk of acute kidney injury. Albumin may benefit hypoalbuminemic patients with sepsis and acute lung injury but may worsen outcome in traumatic brain injury. Early administration of fluid therapy in sepsis may improve survival but may be unnecessary in patients with penetrating trauma. Later fluid therapy in acute lung injury patients will increase the duration of ventilator dependence without achieving better survival. A positive cumulative balance likely contributes to increased morbidity and mortality after major surgery. Summary Emerging evidence shows that choice, timing and amount of fluid therapy affect outcome. Future studies need to focus on these aspects of fluid therapy by means of larger, more rigorous and blinded controlled trials. © 2007 Lippincott Williams & Wilkins, Inc.