Aristotle and the art of fluid resuscitation in sepsis

Sepsis is a common and commonly fatal condition, leading to significant mortality in hospitalized patients, particularly in intensive care units (1). The presentation of sepsis is variable, and the people it affects are diverse, which has created much debate as to the best approach to reduce morbidity and mortality. It is well documented that early intervention with aggressive supportive care, with an emphasis on appropriate antibiotic administration, source control, and volume resuscitation reduces mortality and improves outcomes. In recent years, we have discovered that some of the interventions which had previously been accepted as beneficial in severe sepsis and septic shock have either been found to be ineffective or potentially harmful (2-6). The available evidence has now coalesced largely around early and appropriate antibiotic administration, source control when possible, and volume resuscitation as the most beneficial interventions.