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Optimizing fluid therapy in shock

Marik, Paul E.a; Weinmann, Maxwellb

Current Opinion in Critical Care: June 2019 - Volume 25 - Issue 3 - p 246–251
doi: 10.1097/MCC.0000000000000604

Purpose of review Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock.

Recent findings Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality.

Summary We believe that the approach to fluid therapy must be individualized based on the cause of shock as well as the patient's major diagnosis, comorbidities and hemodynamic and respiratory status. A conservative, physiologically guided approach to fluid resuscitation likely improves patient outcomes.

aDivision of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk

bDirector Acute Respiratory Intensive Care Unit, Emory University Hospital, Atlanta, USA

Correspondence to Paul E. Marik, MD, Chief, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 410, Norfolk VA 23507, USA. E-mail:

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