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Highly Accessed Open Badges Commentary

Totem and Taboo: Fluids in sepsis

Andrew K Hilton1 and Rinaldo Bellomo2*

Author Affiliations

1 Department of Intensive Care, Alfred Hospital, Commercial Road, Melbourne, Australia, Victoria 3181, Australia

2 Australian and New Zealand Intensive Care Research Centre, Commercial Road, Melbourne, Victoria 3181, Australia

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Critical Care 2011, 15:164  doi:10.1186/cc10247

Published: 10 June 2011


The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.