Fluid resuscitation: the good, the bad and the ugly

Fluid resuscitation is one of the most common therapeutic steps in the critically ill. In this brief overview, the goals and potential adverse effects of fluid resuscitation are addressed. The contention is that the value of many of the fluid resuscitation goals in hypovolemic patients has not been unequivocally established, that overhydration is a significant problem and that certain types of fluids can be associated with major adverse effects. Hence, fluid loading should be carefully done and adequately monitored to avoid these effects and to improve survival of patients with hypovolemia and hemodynamic insufficiency.