From the Guidelines
For a 72kg patient with sepsis requiring resuscitation, administer 30mL/kg of crystalloid IV fluid, which equals 2,160mL (72kg × 30mL/kg), within the first 3 hours, as recommended by the Surviving Sepsis Campaign guidelines 1. This typically translates to an initial rate of approximately 720mL per hour.
Key Considerations
- Balanced crystalloids like Lactated Ringer's or Plasma-Lyte are preferred over normal saline when possible.
- After the initial bolus, reassess the patient's hemodynamic status including:
- Blood pressure
- Heart rate
- Capillary refill
- Urine output
- Mental status to determine if additional fluid is needed.
- Fluid resuscitation aims to restore intravascular volume, improve tissue perfusion, and maintain adequate organ function during sepsis.
- Be cautious not to overhydrate, as this can lead to pulmonary edema and other complications.
- If the patient remains hypotensive after adequate fluid resuscitation (MAP <65 mmHg), vasopressors should be initiated, with norepinephrine as the first-line agent, as suggested by the guidelines 1.
- Ongoing fluid needs should be guided by dynamic measures of fluid responsiveness rather than static parameters, as recommended by the guidelines 1.
From the Research
Recommended IV Fluid Rate for Sepsis Resuscitation
The recommended intravenous (IV) fluid rate for sepsis resuscitation is a topic of ongoing debate and research. According to the Surviving Sepsis Campaign guidelines, the current recommendation is to administer 30 ml/kg of fluid 2. However, this recommendation has been questioned by some studies, which suggest that a more conservative approach to fluid resuscitation may be beneficial 3, 4.
Key Findings
- A study published in 2023 found that the current recommendation of 30 ml/kg fluid cannot be applied to all patients, and that complications of fluid over-resuscitation can delay organ recovery and increase mortality 5.
- A 2016 study found that initiation of intravenous fluid resuscitation within 30 minutes of severe sepsis or septic shock identification was associated with reduced mortality and length of stay 6.
- A 2022 review of the current state of evidence for IV fluid resuscitation in septic shock found that there is a paucity of high-level evidence to support the strategy of administering at least 30mL/kg of isotonic crystalloid fluid 2.
- A 2017 study protocol for a pilot randomized controlled trial found that there is currently equipoise regarding liberal or restricted fluid-volume resuscitation as first-line treatment for sepsis-related hypotension 3.
- A 2020 review found that there is no credible evidence to support the recommendation of administering a minimum of 30 mL/kg crystalloid solution intravenously in all patients with septic shock, and that a more restrictive approach to fluid resuscitation may be beneficial 4.
Calculation of Recommended IV Fluid Rate
Based on the recommended 30 ml/kg of fluid, a patient weighing 72 kg would require:
- 30 ml/kg x 72 kg = 2160 ml of fluid
However, it is essential to note that this is a general recommendation, and the actual fluid rate may vary depending on the individual patient's needs and response to treatment.