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Br J Anaesth. 2014 Nov;113(5):740-7. doi: 10.1093/bja/aeu300. Epub 2014 Sep 9.

Four phases of intravenous fluid therapy: a conceptual model.

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Department of Intensive Care Medicine, 2K12-C, Ghent University Hospital, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium Research Foundation Flanders (FWO), Brussels, Belgium.
KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya Wellcome Trust Centre for Clinical Tropical Medicine, Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK.
Department of Anesthesiology, Duke University Medical Center/Durham VAMC, Durham, NC, USA.
Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA, USA.
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Anaesthesia, York Teaching Hospital NHS Foundation Trust, York, UK.
Center for Critical Care Nephrology, CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Anaesthesia, University College London, London, UK.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.


I.V. fluid therapy plays a fundamental role in the management of hospitalized patients. While the correct use of i.v. fluids can be lifesaving, recent literature demonstrates that fluid therapy is not without risks. Indeed, the use of certain types and volumes of fluid can increase the risk of harm, and even death, in some patient groups. Data from a recent audit show us that the inappropriate use of fluids may occur in up to 20% of patients receiving fluid therapy. The delegates of the 12th Acute Dialysis Quality Initiative (ADQI) Conference sought to obtain consensus on the use of i.v. fluids with the aim of producing guidance for their use. In this article, we review a recently proposed model for fluid therapy in severe sepsis and propose a framework by which it could be adopted for use in most situations where fluid management is required. Considering the dose-effect relationship and side-effects of fluids, fluid therapy should be regarded similar to other drug therapy with specific indications and tailored recommendations for the type and dose of fluid. By emphasizing the necessity to individualize fluid therapy, we hope to reduce the risk to our patients and improve their outcome.


adults; critical care; fluid therapy; resuscitation

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