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Fluid resuscitation for acute kidney injury: an empty promise

Watkins, Scott C.; Shaw, Andrew D.

Current Opinion in Critical Care: December 2016 - Volume 22 - Issue 6 - p 527–532
doi: 10.1097/MCC.0000000000000363
RENAL SYSTEM: Edited by John Kellum

Purpose of review The past decade has seen more advances in our understanding of fluid therapy than the preceding decades combined. What was once thought to be a relatively benign panacea is increasingly being recognized as a potent pharmacological and physiological intervention that may pose as much harm as benefit.

Recent findings Recent studies have clearly indicated that the amount, type, and timing of fluid administration have profound effects on patient morbidity and outcomes. The practice of aggressive volume resuscitation for ‘renal protection’ and ‘hemodynamic support’ may in fact be contributing to end organ dysfunction. The practice of early goal-directed therapy for patients suffering from critical illness or undergoing surgery appears to offer no benefit over conventional therapy and may in fact be harmful. A new conceptual model for fluid resuscitation of critically ill patients has recently been developed and is explored here.

Summary The practice of giving more fluid early and often is being replaced with new conceptual models of fluid resuscitation that suggest fluid therapy be ‘personalized’ to individual patient pathophysiology.

aDepartment of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt

bDepartment of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Correspondence to Dr Andrew D. Shaw, MB, FRCA, FFICM, FCCM, Professor and Executive Vice Chair, Department of Anesthesiology, Vanderbilt University School of Medicine, 1211 21st Avenue South, Medical Arts Building, Room 722, Nashville, TN 37212, USA. Tel: +1 615 875 3142; e-mail: andrew.shaw@vanderbilt.edu

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