What are the principles of fluid resuscitation in septic shock?
Nov 05, 2025
Source: Cainiu Health
Dr. Yang Ziqi
Introduction
Septic shock leads to inadequate effective circulating blood volume. It is necessary to rapidly infuse fluids within a short period to quickly increase circulating blood volume and improve tissue perfusion. In the initial phase, crystalloid solutions are typically administered at a certain rate to promptly correct hypotension and tissue hypoxia. Crystalloids, such as normal saline and balanced salt solutions, are preferred for fluid resuscitation because they can rapidly distribute both intravascularly and interstitially.
Principles for fluid resuscitation in septic shock generally include rapid fluid administration for volume expansion, using crystalloids before colloids, individualized dose adjustment, dynamic monitoring of vital signs, and simultaneous correction of electrolyte disturbances. A detailed analysis is as follows:
1. Rapid fluid administration for volume expansion: Septic shock leads to inadequate effective circulating blood volume. Fluids must be administered rapidly within a short time to quickly increase circulating volume and improve tissue perfusion. In the initial phase, crystalloid solutions are typically infused at a specific rate to promptly correct hypotension and tissue hypoxia.
2. Crystalloids before colloids: Crystalloid solutions such as normal saline or balanced salt solutions are preferred initially. These fluids rapidly distribute both intravascularly and interstitially, replenishing extracellular fluid and improving microcirculation. Colloid solutions are considered only when sufficient crystalloid administration fails to maintain circulatory stability.
3. Individualized dose adjustment: The volume of fluid administered should be adjusted based on factors such as body weight, severity of shock, and underlying medical conditions, to avoid complications like pulmonary edema or heart failure due to excessive or blind fluid infusion. Infusion rates and total volumes should be dynamically adjusted according to the patient’s response to ensure both efficacy and safety.
4. Dynamic monitoring of vital signs: During fluid resuscitation, continuous monitoring of blood pressure, heart rate, urine output, central venous pressure, and other parameters is essential. These indicators help assess improvements in circulatory status and determine whether fluid administration is adequate or excessive. If blood pressure does not improve or urine output decreases, the fluid protocol should be promptly adjusted to prevent disease progression.
5. Simultaneous correction of electrolyte imbalances: Electrolyte disturbances such as hypokalemia and hyponatremia commonly accompany septic shock. Electrolyte levels should be monitored concurrently during fluid therapy. Appropriate electrolytes should be added to the infused fluids or administered separately via specific medications to maintain internal electrolyte balance.
Fluid resuscitation must be performed under the guidance of trained medical professionals; patients or caregivers should not adjust the fluid regimen independently. Close observation of the patient’s consciousness, respiration, and other conditions is necessary during fluid administration, and any abnormalities should be immediately reported to healthcare providers.
