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Fluid Resuscitation in Septic Shock

Fluid Resuscitation in Septic Shock: Sepsis/Septic Shock Identified → Initial Fluid Resuscitation: 30 mL/kg → Fluid Type: Balanced Crystalloid → ⚠️ AVOI...

Pathway Overview

14 steps

Algorithm Steps

14 total

  1. 01Start

    Sepsis/Septic Shock Identified

    Hypoperfusion or lactate ≥2 mmol/L

  2. 02Action

    Initial Fluid Resuscitation: 30 mL/kg

    Within first 3 hours (Strong recommendation)

    • 30 mL/kg crystalloid
    • Give within first 3 hours of sepsis recognition
    • Use ideal body weight
    • SSC 2021: Strong recommendation
  3. 03Action

    Fluid Type: Balanced Crystalloid

    Suggest balanced over normal saline

    • Lactated Ringer's or Plasmalyte preferred
    • SSC 2021: Weak recommendation
    • Normal saline acceptable if balanced unavailable
    • AVOID hydroxyethyl starch (HES)
    • Albumin: can consider if large volumes needed
  4. 04Warning

    ⚠️ AVOID Hydroxyethyl Starch

    Strong recommendation AGAINST

    • Associated with AKI and mortality
    • Do NOT use HES for resuscitation
    • Colloids not superior to crystalloids
  5. 05Decision

    Reassess After Initial Resuscitation

    Evaluate hemodynamic status and perfusion

    • Blood pressure/MAP
    • Heart rate
    • Urine output
    • Capillary refill
    • Lactate clearance
    • Mental status
  6. 06Action

    Hemodynamically Responsive

    Adequate response to initial fluids

    • MAP ≥65 mmHg
    • Improving lactate
    • Improving perfusion markers
    • Continue monitoring, conservative fluids
  7. 07Warning

    ⚠️ Watch for Fluid Overload

    Harms of over-resuscitation

    • Pulmonary edema
    • Increased ventilator days
    • Abdominal compartment syndrome
    • Peripheral edema
    • Conservative strategy after initial resuscitation
  8. 08Outcome

    Adequately Resuscitated

    MAP ≥65, lactate clearing, perfusion improving

  9. 09Decision

    Persistent Hypoperfusion

    Not responsive to 30 mL/kg

  10. 10Action

    Assess Fluid Responsiveness

    Guide additional fluid boluses

    • Passive leg raise (PLR) + CO monitoring
    • Pulse pressure variation (if applicable)
    • Stroke volume variation
    • Ultrasound (IVC, cardiac)
    • Avoid static measures (CVP alone)
  11. 11Decision

    Fluid Responsive?

    Will additional fluids improve CO?

  12. 12Action

    Give Additional Fluid Bolus

    250-500 mL boluses, reassess after each

    • 250-500 mL crystalloid bolus
    • Reassess after each bolus
    • Stop when no longer responsive
    • Watch for signs of fluid overload
  13. Path rejoins step 05Shared downstream outcome
  14. 13Action

    Start/Escalate Vasopressors

    If not fluid responsive

    • Norepinephrine first-line
    • Can start during resuscitation if severe
    • MAP target ≥65 mmHg
    • See vasopressor algorithm
  15. 14Outcome

    Ongoing Shock

    Continue vasopressors, reassess daily fluid status

Guideline Source

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

DOI: 10.1007/s00134-021-06506-yView Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Does not address cardiogenic shock (restrict fluids)
  • 30 mL/kg may need modification in heart failure/renal failure
  • Fluid responsiveness assessment varies by method
  • Does not specify exact timing cutoffs
  • Local protocols may differ

Contraindicated Populations

pediatricneonatal

Applicable Regions

USEUGlobal

Global: SSC 2021 guidelines

Version 1Next review: 2027-01-01

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Frequently Asked Questions

What is the Fluid Resuscitation in Septic Shock?

The Fluid Resuscitation in Septic Shock is a management clinical algorithm for Critical Care. It provides a structured decision tree to guide clinical decision-making, based on Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.

What guideline is the Fluid Resuscitation in Septic Shock based on?

This algorithm is based on Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 (DOI: 10.1007/s00134-021-06506-y).

What are the limitations of the Fluid Resuscitation in Septic Shock?

Known limitations include: Does not address cardiogenic shock (restrict fluids); 30 mL/kg may need modification in heart failure/renal failure; Fluid responsiveness assessment varies by method; Does not specify exact timing cutoffs; Local protocols may differ. Individual patient factors may require deviation from these recommendations.

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