Optimizing fluid therapy in shock

Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock.Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality.We believe that the approach to fluid therapy must be individualized based on the cause of shock as well as the patient's major diagnosis, comorbidities and hemodynamic and respiratory status. A conservative, physiologically guided approach to fluid resuscitation likely improves patient outcomes.