Fluid selection
The results of numerous trials support the preferential use of
crystalloid, the avoidance of hydroxyethyl starches (HES),
and the select use of albumin only after large quantities of crystalloid
administration. Crystalloid has repeatedly shown to be
cheaper, and has either no mortality difference or a lower mortality
in comparison HES, along with a decreased need for
renal replacement therapy (RRT) and is strongly recommended.
8,29,30 Additionally, it is important to note that while
there are emerging data on the potential benefits of using balanced
crystalloid solutions (e.g., Ringer’s lactate) as opposed
to chloride-rich fluids (e.g., normal saline), the primary consideration
in LMICs should be on ensuring adequate crystalloid
volume resuscitation regardless of the type.31,32 It is important
to reiterate here that this review focuses on adult patients, as a
study of over 3000 children in shock with febrile illnesses who
were randomized to fluid boluses vs. no boluses demonstrated
an increased mortality in the fluid bolus group.33 The applicability
of this trial to adult patients has yet to be established.
In resource-limited settings, use crystalloids liberally. The
type of crystalloid infusion is not as important as the volume
given.