Totem and Taboo: Fluids in sepsis
1 Department of Intensive Care, Alfred Hospital, Commercial Road, Melbourne, Australia, Victoria 3181, Australia
2 Australian and New Zealand Intensive Care Research Centre, Commercial Road, Melbourne, Victoria 3181, Australia
Critical Care 2011, 15:164 doi:10.1186/cc10247Published: 10 June 2011
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.