Fluid resuscitation of hypovolemic shock: acute medicine's great triumph for children.

摘要

The World Health Organization (WHO) lists diarrhea, malaria, and bacterial sepsis as three of the leading causes of death of infants and children worldwide. Because fluid resuscitation reduces mortality tenfold in each of these conditions, a worldwide initiative now exists on the importance of improving access to this type of acute therapy. Two global priorities for realizable and cost efficient improvement in child survival are therefore: (1) improved access to facilities capable of time-sensitive intravenous fluid resuscitation, and (2) clinical studies that determine which fluid composition(s) best attain early resuscitation goals in various forms of hypovolemic shock. However, consensus has not been fully reached on the type of isotonic fluids to be used in each form or condition associated with hypovolemic shock [1, 2, 3, 4, 5]. In this issue of Intensive Care Medicine, colleagues from the Netherlands share their national guidelines for use of fluid resuscitation and provide support for their contention that in their population of children, initial resuscitation with isotonic crystalloid is indicated .