Pathophysiology of fluid administration in critically ill patients

Antonio Messina*, Jan Bakker, Michelle Chew, Daniel De Backer, Olfa Hamzaoui, Glenn Hernandez, Sheila Nainan Myatra, Xavier Monnet, Marlies Ostermann, Michael Pinsky, Jean Louis Teboul, Maurizio Cecconi

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

13 Citations (Scopus)
23 Downloads (Pure)


Fluid administration is a cornerstone of treatment of critically ill patients. The aim of this review is to reappraise the pathophysiology of fluid therapy, considering the mechanisms related to the interplay of flow and pressure variables, the systemic response to the shock syndrome, the effects of different types of fluids administered and the concept of preload dependency responsiveness. In this context, the relationship between preload, stroke volume (SV) and fluid administration is that the volume infused has to be large enough to increase the driving pressure for venous return, and that the resulting increase in end-diastolic volume produces an increase in SV only if both ventricles are operating on the steep part of the curve. As a consequence, fluids should be given as drugs and, accordingly, the dose and the rate of administration impact on the final outcome. Titrating fluid therapy in terms of overall volume infused but also considering the type of fluid used is a key component of fluid resuscitation. A single, reliable, and feasible physiological or biochemical parameter to define the balance between the changes in SV and oxygen delivery (i.e., coupling “macro” and “micro” circulation) is still not available, making the diagnosis of acute circulatory dysfunction primarily clinical.

Original languageEnglish
Article number46
JournalIntensive Care Medicine Experimental
Issue number1
Publication statusPublished - 4 Nov 2022

Bibliographical note

Funding Information:
None to declare.

Publisher Copyright:
© 2022, The Author(s).


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