Restraint in Fluid Resuscitation for Seriously Ill Patients

Resuscitation is a central part of the care of many critically ill patients, including those with septic shock and severe pancreatitis. For years, emphasis was placed on rapid administration of large volumes of fluid to ensure tissue perfusion in these patients. More recently, we have become more nuanced about how much fluid is “enough,” as complications of aggressive resuscitation (e.g., pulmonary edema, anasarca) have been noted. In 2022, two new studies added to that knowledge.

Spanish investigators randomized 249 patients with acute pancreatitis to either aggressive or moderate fluid resuscitation with lactated Ringer's solution. They excluded patients who presented with “moderately severe or severe” pancreatitis — for example, those wit…