Deleterious effects of aggressive fluid resuscitation.
The harmful effects of aggressive fluid resuscitation on the outcome of sepsis are supported by experimental studies and data accumulated from clinical trials. Multiple clinical studies have demonstrated an independent association between an increasingly positive fluid balance and increased mortality in patient with sepsis. The most compelling data that fluid loading in sepsis is harmful, comes from the landmark ‘ Fluid Expansion as Supportive Therapy (FEAST)’ study performed in 3141 sub-Saharan children with severe sepsis. In this randomized study, aggressive fluid loading was associated with a significantly increased risk of death. After the Rivers' Early Goal Directed Therapy trial, which formed the basis for the concept of early aggressive fluid resuscitation, a number of EGDT studies have been published.