Intravenous fluid therapy

The aim of intravenous fluid therapy is to increase tissue oxygen delivery by restoring normal intravascular fluid volume with an appropriate hematocrit. This will also increase preload (Fig 1), and hence cardiac output and oxygen delivery.

In some cases the choice of intravenous fluid is obvious. If the patient is bleeding and losing blood, the fluid replacement will be primarily blood. If the patient has a fistula or large burns, the initial fluid therapy should be matched to replace these losses. However, in many patients the cause of reduced intravascular volume is not immediately obvious. In these cases the intravascular volume should be restored and the hematocrit maintained.

There have been numerous attempts to establish whether intravenous crystalloid or artificial colloidal solutions are most appropriate for resuscitation in these patients and this issue is unresolved.

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