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Fluid Management in Septic Shock

Background: Treating hypovolemia remains a central tenet of early management of severe sepsis. Goal directed fluid therapy has been shown to enhance survival when given within the first 6 hours after presentation. However, additional fluids in a resuscitated state can lead to respiratory failure, and it has been shown that a positive fluid balance in sepsis patients increases mortality and the risk for and duration of intubation. Precise end points for fluid resuscitation are yet to be defined, and there is recent evidence that aggressive fluid therapy in resuscitated sepsis after the time limit of 6 hours, can lead to a higher incidence of respiratory failure.