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We chose to administer maximal fluid challenge to avoid any possibility of fluid underresuscitation.
In the most extreme example, one might see some physicians administer fluids while other physicians facing the same clinical situation diurese.
In developed countries, the standard treatment for diarrhea was to administer an intravenous fluid, a costly procedure requiring hospitalization.
Recent studies have investigated the feasibility of closed-loop systems to automatically administer fluid during the perioperative period [47].
We usually administer fluid challenges with normal saline at a 7 mL/kg dose over a 30-min period and perform thermodilution before and after each challenge.
Patients were prospectively included if they presented an acute circulatory failure for which the attending physician had decided to administer fluid.
However, the decision of the ICU attending to administer fluid was based on clinical signs of inadequate tissue perfusion (e.g. escalating vasopressor requirement, decreasing urine output, etc).
Obviously, the easiest way to test preload responsiveness is to administer fluid and to observe the resulting effect on cardiac output.
Ordinarily, the clinician will administer fluid or inotropic therapy (or both) on a subjective basis according to their preferred clinical end-points.
We did not administer fluid resuscitation, although such resuscitation is typically performed in human sepsis and might have modified our findings.
However, the optimal approach for administering intravenous fluid in septic shock resuscitation is unknown.
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