Fluid responsiveness is not fixed, and the benefit of each bolus falls as resuscitation continues. Reassessing after each bolus — perfusion, blood pressure, urine output, lactate trend, and signs of overload such as rising oxygen need or crackles — guides whether to give more or move to vasopressors.
Noradrenaline can be started through a well-functioning peripheral cannula for a short period while central access is arranged, under local protocols with site monitoring.
- Reassess perfusion and oxygenation after each bolus rather than giving a fixed volume.
- Watch for rising oxygen requirement and crackles as early signs of fluid overload.
- Consider peripheral noradrenaline under protocol rather than delaying for central access.
- Follow the lactate trend, not a single value.
Why it matters
The harm in resuscitation usually comes from continuing a strategy without checking whether it is still working.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for emergency & critical care, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free