Researchers shed light on optimal IV fluid therapy for treating sepsis, the silent killer in ICUs

University of Alberta researchers are providing answers on how to use intravenous fluids to treat sepsis, a deadly condition that affects nearly a third of all patients in intensive care units. 

Despite the fact that IV fluid therapy is one of the standard pillars of care for sepsis, it's not always a sure bet, and can sometimes make sepsis worse. Which fluids to give, how much to give and when have been fiercely debated for years. A new JAMA article sums up the latest science on the phases of sepsis and how much IV fluid to give at each stage of treatment. 

“This is an intervention that is cheap and easy to use and it can be life-saving, but it can also be harmful for patients if too much fluid is given,” explains first author Fernando Zampieri, an assistant professor of critical care medicine at the U of A.    

Twenty-five per cent of patients who develop sepsis die from it, and it’s responsible for 11 million deaths per year, Zampieri estimates. Sepsis is an extreme response by the body to an infection, leading to a drop in blood pressure and thus a lack of oxygen circulation. Death occurs when oxygen-deprived organs such as the brain, kidneys or liver fail. Treatment almost always includes administering intravenous fluids, along with other interventions such as antibiotics and medications to boost blood pressure and oxygen delivery to tissues. The goal is to restore circulation without causing edema, or swelling, which can also be harmful to organs. 

As Zampieri points out, sepsis is not really one disease, but a complex condition with multiple causes. 

“When we talk about sepsis, you can be talking about things as different as a young woman with an infection after delivery all the way through to an elderly patient with a urinary tract infection. Those are two completely separate sources of infection, and the patient's other conditions make treatment more complicated,” he says.

Zampieri says there are numerous clinical trials underway to refine sepsis treatment, but much is still unknown. He has been involved in several and eventually hopes to develop an accurate bedside test, such as using ultrasound, to better determine what level of fluids a patient requires.  

Sean Bagshaw, a co-author of the review and Canada Research Chair in Critical Care Outcomes and Systems Evaluation, expects sepsis treatment to improve rapidly over the next decade thanks to such work.

“It took us 30 or 40 years to get to this point, and I think there's still lots of questions to be answered about how best to individualize the resuscitation strategies amongst patients with life-threatening infection and sepsis,” Bagshaw says. “My hope is that Fernando will help catalyze some of those advances here at the U of A.”