Skip to content


  • Letter
  • Open Access

What is the optimal fluid status in critically ill patients?

Critical Care201216:443

  • Published:


  • Natriuretic Peptide
  • Central Venous Pressure
  • Brain Natriuretic Peptide
  • Septic Patient
  • Fluid Volume

Smith and Perner [1] reported that septic patients with shock for three days or more who received higher fluid volumes had reduced mortality. This is an important issue because how much fluid is enough for critically ill patients has been controversial for a long time. The optimal fluid status should be set according to the prevailing conditions. In contrast to this study, most previous studies have found that a more positive fluid balance is associated with higher mortality [2, 3]. Too much fluid induces interstitial edema, which results in end organ damage, poor wound healing and nosocomial infection [4].

In order to clarify the correlation between fluid therapy and mortality, it is necessary to use high or low fluid volumes as a covariate in a Cox's proportional hazards model of mortality. As we know, fluid resuscitation is a critical step to achieve early goal-directed therapy. Whether patients achieved the goal or not should also be included in analysis. Other parameters related to fluid status, such as central venous pressure level, body composition detected by bioimpedance device, and brain natriuretic peptide level, can be added to the analysis in future studies.


Authors’ Affiliations

Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin branch, Yunlin County, Taiwan


  1. Smith SH, Perner A: Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort. Crit Care. 2012, 16: R76-10.1186/cc11333.PubMedPubMed CentralView ArticleGoogle Scholar
  2. Payen D, Cornélie A, Sakr Y, Spies C, Reinhart K, Jean Louis Vincent, the Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators: A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008, 12: R74-10.1186/cc6916.PubMedPubMed CentralView ArticleGoogle Scholar
  3. Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to Improve Care in Acute Renal Disease (PICARD) Study Group: Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009, 76: 422-427. 10.1038/ki.2009.159.PubMedView ArticleGoogle Scholar
  4. Prowle JR, Echeverri JE, Ligabo EV, Ronco C, Bellomo R: Fluid balance and acute kidney injury. Nat Rev Nephrol. 2010, 6: 107-115. 10.1038/nrneph.2009.213.PubMedView ArticleGoogle Scholar


© BioMed Central Ltd 2012