• Neal Greenfield and Robert A Balk.
• Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush Medical College, Chicago, IL.
• Hosp Pract (1995). 2012 Apr 1;40(2):147-57.

AbstractFluid resuscitation is a cornerstone in the treatment of severe sepsis and septic shock. However, there is little evidence to guide clinicians in its administration. Current guidelines recommend targeting fluid therapy based on measurements of cardiac filling pressures, such as central venous pressure. Static pressures are poor predictors of a patient's response to fluid. Such response can be better predicted by measuring changes in hemodynamic parameters caused by positive pressure ventilation or maneuvers designed to simulate increased preload. These changes can be measured by analysis of arterial waveforms, echocardiography or Doppler, or with emerging noninvasive technologies. This article reviews the current role of fluid replacement strategies and the use of monitoring systems in the overall resuscitation of patients with severe sepsis and septic shock.

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