Fluid resuscitation is a series of tests, not a fixed volume. After each bolus, look for improvement in perfusion, such as heart rate, mean arterial pressure, capillary refill, mental state, urine output and lactate trend, and for signs of harm: rising respiratory rate, falling saturation, new crackles or a distended neck vein.
When perfusion does not improve or signs of overload appear, the next step is a vasopressor rather than more fluid. Noradrenaline can be started through a well-sited peripheral cannula while central access is arranged.
- Give fluid in boluses and reassess perfusion and oxygenation after each one.
- Stop fluid when perfusion fails to improve or lungs begin to fill.
- Start noradrenaline peripherally through a large, well-sited cannula if hypotension persists.
- Record the cumulative fluid given in the first six hours.
Why it matters
Fluid overload in the first hours of sepsis is common, avoidable and harmful.
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