Editing Sepsis (section)

=== Intravenous fluids ===
The [[Surviving Sepsis Campaign]] has recommended 30 mL/kg of fluid to be given in adults in the first three hours followed by fluid titration according to blood pressure, urine output, respiratory rate, and oxygen saturation with a target [[mean arterial pressure]] (MAP) of 65 mmHg.<ref name= "SSC–G2016"/> In children an initial amount of 20 mL/kg is reasonable in shock.<ref name="de Caen2015"/> In cases of severe sepsis and septic shock where a [[central venous catheter]] is used to measure blood pressures dynamically, fluids should be administered until the [[central venous pressure]] reaches 8–12 mmHg.<ref name="Marik2014"/> Once these goals are met, the central venous oxygen saturation (ScvO2), i.e., the oxygen saturation of venous blood as it returns to the heart as measured at the vena cava, is optimized.<ref name= "SSC–G2016"/> If the ScvO2 is less than 70%, blood may be given to reach a hemoglobin of 10&nbsp;g/dL and then [[inotrope]]s are added until the ScvO2 is optimized.<ref name=Critical2005 /> In those with [[acute respiratory distress syndrome]] (ARDS) and sufficient tissue blood fluid, more fluids should be given carefully.<ref name=SSCG2012/>

[[Crystalloid solution]] is recommended as the fluid of choice for resuscitation.<ref name= "SSC–G2016"/> [[Albumin]] can be used if a large amount of crystalloid is required for resuscitation.<ref name= "SSC–G2016"/> Crystalloid solutions shows little difference with [[hydroxyethyl starch]] in terms of risk of death.<ref name=Lew2018/> Starches also carry an increased risk of [[acute kidney injury]],<ref name=Lew2018 /><ref name= Zarychanski2013/> and need for blood transfusion.<ref name=Haase2013/><ref name=Serpa2014/> Various colloid solutions (such as modified gelatin) carry no advantage over crystalloid.<ref name=Lew2018 /> Albumin also appears to be of no benefit over crystalloids.<ref name=Patel2014/>