RESUSCITATION
Fluid therapy and shock: an integrative
literature review
Joana Silva, Luís Gonçalves and Patrícia Pontífice Sousa
S
hock refers to a complex physiological situation
that puts life at risk (Monahan et al, 2010). It
is the clinical manifestation of inadequate tissue
perfusion, resulting in changes at the cellular,
metabolic and haemodynamic levels (Urden
et al, 2008; Howard and Steinmann, 2010). When shock is
initiated, there is an inadequate supply of oxygen to the cells
with cellular dysoxia occurring. When hypoxia sets in, the
body’s cells do not receive the oxygen or nutrients they need,
and cannot eliminate the metabolic byproducts (Howard and
Steinmann, 2010). If such functional cellular disturbance is
not treated, it will result in multiorgan dysfunction and death
(Monahan et al, 2010).
Aetiology
Shock can be classified as hypovolaemic, cardiogenic or
distributive according to the pathophysiological cause that is
at its origin (Monahan et al, 2010).
Hypovolaemic shock is the most common form of shock. It
is caused by loss of whole blood, plasma, or interstitial fluid in
amounts that do not allow the satisfaction of the metabolic needs of
the organism. It can be caused by absolute or relative hypovolaemia.
Absolute hypovolaemia is due to an external loss of fluid, as
happens in the case of haemorrhage, and relative hypovolaemia
results from displacement of fluid from the intravascular to the
extravascular space (Monahan et al, 2010). Haemorrhagic shock
is a form of hypovolaemic shock (Howard and Steinmann, 2010).
Cardiogenic shock results from impairment of the heart’s
ability to pump blood. Reduction of cardiac output and
concomitant inadequate peripheral vascular resistance occurs
to compensate for the reduction in tissue perfusion (Monahan
et al, 2010).
Distributive shock arises when there is vascular tone
inadequacy and it causes generalised vasodilation. Vascular
Joana Silva, Medical-Surgical Nursing Specialist, Cardiac
Intensive Care Unit, Professor Doutor Fernando Fonseca Hospital,
Lisbon, Portugal
Luís Gonçalves, Medical-Surgical Nursing Specialist, Emergency
and Resuscitation Medical Vehicle of Cascais, near Lisbon,
© 2018 MA Healthcare Ltd
Portugal
Patrícia Pontífice Sousa, Assistant Teacher, Portuguese Catholic
University, Lisbon, Portugal
Accepted for publication: April 2018
British Journal of Nursing, 2018, Vol 27, No 8449
ABSTRACT
Background: shock refers to a physiological situation that puts life at risk.
Its early identification and the timely institution of therapeutic measures
can avoid death. Despite the frequent administration of fluid therapy as
a treatment for shock, the type and dose of fluids to be delivered remain
undetermined. Aim: to determine the type of fluids to be administered and
the type of approach to be performed in the different types of shock. Method:
integrative literature review. Results: data about fluid therapy in hypovolaemic
and distributive shock were obtained, specifically in the haemorrhagic and the
septic types. None of the articles addressed cardiogenic shock. Conclusion:
hypotensive resuscitation, with blood, is the most appropriate approach in
haemorrhagic shock. There remains a question regarding the best approach
in septic shock. However, conservative fluid therapy seems to be appropriate,
with preference given to the administration of balanced crystalloids or
albumin as an alternative.
Key words: Fluid therapy  ■ Shock  ■ Haemorrhagic shock  ■ Septic shock
■Evidence-based practice
volume is adequate, as well as the pumping of blood by the heart.
However, the vascular space increases, generating imbalances
in the distribution of blood through the circulatory system.
Distributive shock can be further divided into septic, neurogenic
and anaphylactic types (Monahan et al, 2010).
Fluid therapy in shock approach
The goal in shock treatment is the preservation and the
improvement of tissue perfusion.This depends on an adequate
supply and transport of oxygen, as well as on the cellular
ability to use it. Achieving the appropriate haemoglobin and
cardiac output levels is essential for the transport of oxygen.
Fluid therapy is instituted to optimise cardiac output, which
is supported by the preload, afterload and contractility of the
heart and the heart rate (Urden et al, 2013). In this context,
fluid therapy promotes an increase in intravascular volume and
preload and improvement of cardiac contractility and output,
in order to optimise tissue perfusion (Monahan et al, 2010).
Types of resuscitation fluids
There are two types of resuscitation fluids: crystalloids and
colloids (Frazee and Kashani, 2016).
Crystalloids are solutions consisting of ions that will
determine the tonicity of the fluid (Semler and Rice, 2016).
This type of fluid moves easily from the intravascular to the
Downloaded from magonlinelibrary.com by 131.172.036.029 on April 24, 2018.

EBSCOhost
CINAHL Complete and MEDLINE Complete
Criteria:
fluid therapy AND shock ■■ 2014–2016
■■ Full-text available
174 articles Relevance of the title:
Articles excluded due to
referring to paediatric
population, to animal studies,
or not appropriate for topic
Its pH is also lower. Lactated Ringer’s solution or Plasma-Lyte
(Baxter) are more balanced saline solutions than 0.9% NaCl
(Frazee and Kashani, 2016).
Colloids are made up of proteins that increase the osmotic
pressure and, as such, remain longer in the vascular system.
Optimised osmotic pressure will attract and retain fluid in the
vascular space, with lower volumes being required compared to
crystalloids (Monahan et al, 2010; Frazee and Kashani, 2016).
Albumin and starches are examples of commonly used colloids.
Human albumin is a natural colloid synthesised in the liver and
is responsible for most of the intravascular oncotic pressure.
Starches used in this context are a group of semisynthetic
colloids that result from hydroxyethylation of potato, corn or
sorghum amylopectin.

28 articles Aim
Abstract-level review:
Despite the frequent administration of fluid therapy, in order to
Articles excluded due to not
optimise blood volume and maintain organ perfusion at shock,
addressing intended subject,
or not being in Portuguese or the type and dose of fluids to be delivered remain undetermined
English languages (Frazee and Kashani, 2016). Therefore, the aim of this review
20 articles was to determine the type of fluids to be administered and the
type of approach to be performed (aggressive versus permissive
Full-text review: resuscitation) in the different types of shock.
Articles excluded due to not
answering research question Method
In order to address the research question an integrative review
8 articles of the literature was carried out. For this, the EBSCOhost
platform was used, where the following databases were selected:
CINAHL Complete and MEDLINE Complete. Subsequently,
Figure 1. Breakdown of literature search a Boolean type literature search was performed of literature
published in the previous two years (between 2014 and 2016)
tissue space. If large volumes of crystalloids are administered, using the following terms: fluid therapy AND shock. Applying
haemodilution of red blood cells and plasma proteins may the criterion of full-text article available, 174 articles were
occur, compromising the supply of oxygen to the tissues and the obtained, on which a revision of the titles was carried out, to
decrease in osmotic pressure, with an inherent risk of developing exclude those referring to the paediatric population, animal
pulmonary oedema (Monahan et al, 2010). An example of a studies, or that were not appropriate to the subject matter.Thus,
crystalloid is normal saline, i.e. 0.9% sodium chloride (NaCl) 28 articles were obtained to be reviewed at the abstract level. On
solution. However, despite this designation, the solution is not, in the basis of the relevance of the abstract, articles were selected
fact, physiologically normal because it has a higher concentration to be reviewed at full-text level. Figure 1 shows this process.
of chloride ions than plasma, and there is difference in the The eight remaining articles were classified according to
constituent ions (Frazee and Kashani, 2016; Reddy et al, 2016). the level of evidence (Melnyk and Fineout-Overholt, 2005):
■■ Level I—evidence from meta-analyses of controlled and
Table 1. Articles included in literature review randomised clinical trials
■■ Level II—evidence from individual experimental studies
Authors Year Level of Type of shock adressed
■■ Level III—evidence from quasi-experimental studies
evidence
■■ Level IV—evidence from qualitative or non-experimental
Baker et al 2016 V Hypovolaemic (haemorrhagic) descriptive studies
Butler et al 2014 V Hypovolaemic (haemorrhagic) ■■ Level V—evidence from experience or case reports
■■ Level VI—evidence from experts’ opinions.
Mattox 2015 V Hypovolaemic (haemorrhagic)

Chen and Kollef 2014 I Distributive (septic) Results

Of the eight articles included in this integrative review, three
© 2018 MA Healthcare Ltd

Corrêa et al 2015 V Distributive (septic)

dealt with fluid therapy in hypovolaemic shock (specifically
Rastegar 2015 V Distributive (septic) haemorrhagic shock), and the remaining five dealt with
Rochwerg et al 2014 I Distributive (septic) distributive shock (specifically septic shock). None of the articles
addressed cardiogenic shock. Table 1 illustrates this.
Rochwerg et al 2015 I Distributive (septic)
The data obtained on hypovolaemic shock were all related

450 British Journal of Nursing, 2018, Vol 27, No 8

Downloaded from magonlinelibrary.com by 131.172.036.029 on April 24, 2018.


to the haemorrhagic type. Concerning this type of shock, the
analysed articles came to the conclusion that the preferred
approach should be the administration of blood and derivatives,
and hypotensive resuscitation. Table 2 shows the main findings
related to haemorrhagic shock.
The data obtained in the context of distributive shock were
all related to septic shock. Of the five articles analysed, four
focused on the type of fluid therapy to be chosen in septic
shock, with a consensus regarding a preference for crystalloids,
especially balanced ones. Albumin was also referred to as an
alternative in all articles. They all stated that starches are to be
avoided in this type of shock. Regarding the type of approach
to septic shock, two of the five articles obtained advocated
conservative fluid therapy.The remaining articles did not refer
to this issue. Table 3 shows the obtained results.
Discussion
Fluid therapy and haemorrhagic shock
Resuscitation of the patient in haemorrhagic shock continues to
provoke controversy, especially regarding the type and amount
of fluids to be administered and the introduction of permissive
hypotension (Howard and Steinmann, 2010). However, evidence
shows that conservative (rather than aggressive) fluid therapy
strategies have been associated with decreased mortality in
trauma victims (Polderman and Varon, 2015). The main aim
of this hypotensive resuscitation is to minimise the risk of
complications associated with aggressive resuscitation and to
reduce interference in the homeostasis responses of the organism
(Butler et al, 2014).
In the first half of the 20th century, despite increasing
attention to physiological changes due to haemorrhagic shock,
the objective was to return blood pressure levels to those seen
before shock set in (Mattox, 2015). It is now scientifically
proven that, during active bleeding, blood pressure should
be treated on the basis of the patient’s response and not
on the basis of a reference value. In fact, aggressive volume
replacement exacerbates the expulsion of clots, hypothermia
and coagulopathy (Howard and Steinmann, 2010). Butler et
al (2014) also reported pulmonary oedema, compartment
syndrome, acidosis, and increased cerebral oedema as adverse
effects of administration of large volumes of crystalloids. Keeping
post-traumatic patients relatively hypotensive or restricting the
administration of crystalloids prevents respiratory failure, and
also loss of plasma and red blood cells (Mattox, 2015). Despite
adopting the view of hypotensive resuscitation described here,
Baker et al (2016) warned that it should be performed within the
golden hour, given that the patient runs the risk of developing
end-organ injury and refractory shock.
Due to the evidence, restriction in fluid therapy administration
is widely used in trauma systems. In fact, there is evidence that
restricting the volume of fluids during resuscitation of patients
with uncontrolled haemorrhage is beneficial. According to
© 2018 MA Healthcare Ltd
Butler et al (2014), in the case of controlled bleeding, including
compressible bleeding, the approach is different, and there must
be careful monitoring of whether the established fluid therapy
results in recurrent bleeding.
Regarding the type of fluids to be used, there seems to be a
British Journal of Nursing, 2018, Vol 27, No 8451
RESUSCITATION
Table 2. Main findings in haemorrhagic shock
Authors Type of shock Type of fluid therapy
resuscitation
Baker et al Hypotensive resuscitation Fresh whole blood, and in case of
(2016) within the golden hour unavailability of this, semisynthetic
colloids for initial volume expansion
Butler et al Hypotensive resuscitation 1st—whole blood
(2014) 2nd—1:1:1 plasma, red blood cells, and
platelets
3rd—1:1 plasma and red blood cells
4th—reconstituted dried plasma, liquid
plasma, or thawed plasma only, or red
blood cells only
5th—Hextend
6th—lactated Ringer’s or Plasma-Lyte A
Mattox Hypotensive resuscitation Blood, plasma and platelets
(2015)
movement away from crystalloids to blood and its constituents,
as this review corroborates. In fact, clinical research in the last
decade has demonstrated the need for the administration of
red blood cells, plasma and platelets in resuscitation of shock,
namely in the 1:1:1 ratio, and this has been shown to be
more important than the administration of various crystalloid
solutions (Mattox, 2015).
In the course of the Iraq and Afghanistan conflicts, it was
found that the administration of large volumes of crystalloids
and small volumes of plasma, used in prehospital resuscitation,
exacerbated trauma-associated coagulopathy. So, a strategy
of plasma administration in the same ratio as red blood cells
was developed. When available, concomitant administration
of platelets has been shown to improve outcomes (Butler et
al, 2014). However, the ratio 1:1:1 of red blood cells, plasma,
and platelets is an attempt to approximate administration of
whole blood, and the use of the latter is preferable, since the
use of the 1:1:1 option is more likely to lead to anaemia,
thrombocytopaenia and coagulopathies compared with whole
blood (Butler et al, 2014; Mattox, 2015). Indeed, there is little
evidence that the administration of blood components is
equivalent to whole blood administration in haemorrhagic
shock.Whole blood is rich in platelets and coagulation factors,
reverses intravascular volume deficiency, and restores the ability
to deliver oxygen (Butler et al, 2014). The administration of
fresh whole blood is also referred to as the fluid therapy of
choice in haemorrhagic shock by Baker et al (2016).
Administration in the 1:1 ratio of plasma and red blood
cells is referenced by Butler et al (2014) as the third option
in resuscitation of haemorrhagic shock, when the above
options are not available. Resuscitation with red blood cells
and plasma has been shown to improve acid-base balance and
reduce early mortality compared with crystalloids. The same
authors refer to the administration of several types of plasma
(reconstituted dried plasma, liquid, or thawed) alone or only
red blood cells as a subsequent option in the resuscitation of
haemorrhagic shock, because plasma transfusion is a standard
Downloaded from magonlinelibrary.com by 131.172.036.029 on April 24, 2018.
 Table 2. Main findings in septic shock
Authors Type of shock Type of fluid therapy
resuscitation
Chen and Conservative fluid therapy No recommendations
Kollef (2014) (suggested)
Corrêa et al No recommendations on Crystalloids (balanced, preferably) or
(2015) the approach regarding albumin (when there is a great need for
quantity of fluids (only fluids)
type) Avoid starches
Rastegar Conservative fluid therapy Balanced crystalloids or albumin
(2015) (suggested)
Avoid starches
Rochwerg et No recommendations Balanced crystalloids or albumin
al (2014) Starches not recommended
Rochwerg et No recommendations Crystalloids (balanced, preferably) or
al (2015) albumin
Avoid starches
approach in the treatment of coagulopathy associated with
trauma, and its prehospital administration has been shown to
improve the International Normalised Ratio (the measure of
clotting time) on arrival at the emergency department. There
is also growing recognition of the need to restore the factors
present in plasma during shock resuscitation in order to restore
homeostasis. Regarding the isolated administration of red blood
cells, a retrospective study by Brown et al (2015) demonstrated
a significant reduction in 24-hour and 30-day mortality in
patients who received red blood cells prior to arrival at the
trauma centre.
Semi-synthetic colloids, namely Hextend (BioTime Inc),
appeared as the next option in the resuscitation of haemorrhagic
shock for Butler et al (2014). According to them, Hextend is
the fluid of choice for resuscitation if blood and its derivatives
are unavailable. Indeed, it remains longer in the intravascular
space compared with crystalloids, providing a more stable
resuscitation as less volume is required, and thus reducing the
iatrogenic complications caused by the oedema provided by the
crystalloids. Baker et al (2016) warned of the risk of increased
incidence of kidney disease and coagulopathy if semisynthetic
colloids are used, worsening outcomes for the patient. Thus,
they recommended the use of semisynthetic colloids only for
initial volume expansion in haemorrhagic shock while blood
administration is not available.
Balanced crystalloids such as lactated Ringer’s solution
or Plasma-Lyte A appear as the last option in haemorrhagic
shock resuscitation, according to Butler et al (2014). This
corroborates the shift away from using crystalloids rather
than blood and derivatives, as Mattox (2015) related. Lactated
Ringer’s is preferable to normal saline because it does not
cause the hyperchloraemic acidosis that normal saline does
due to its high concentration of chloride ions (Butler et al,
2014; Baker et al, 2016). Plasma-Lyte A, compared with saline,
demonstrated better acid-base balance and lower incidence of
hyperchloraemia, although improvement in survival did not
occur in the performed study. The lower cost compared with
452
Hextend was also a point in favour of these balanced crystalloids
(Butler et al, 2014).
Fluid therapy and septic shock
The treatment of septic shock has been the focus of attention
in recent years (Howard and Steinmann, 2010), namely with
regard to the best method of administering fluid therapy in
order to optimise patient outcomes (Chen and Kollef, 2014).
In fact, resuscitation of this type of shock can be successful
only through the patient receiving, at an early stage, the correct
amount and type of fluids, as reported by Corrêa et al (2015).
Guidelines issued by the Surviving Sepsis Campaign
(Dellinger et al, 2013) suggest goal-directed therapy for
intravenous fluid administration, in the first 6 hours of septic
shock. However, there are clinicians who are reluctant to
adopt this approach (Chen and Kollef, 2014), which uses
fluid therapy to achieve haemodynamic goals (Corrêa et
al, 2015). Indeed, the data obtained in this review do not
seem to corroborate such an approach, and seem to favour
an approach based on conservative fluid therapy or at least
considering its applicability to septic shock.
It is now recognised that an excess of fluid therapy can
trigger complications such as acute respiratory distress syndrome,
cerebral oedema, abdominal compartment syndrome and
coagulopathy. Thus, Chen and Kollef (2014) suggested that
clinicians need to be aware of the potential risks of excessive
fluid therapy in septic shock, corroborating the meta-analysis
performed by them. Rastegar (2015) warned that health
professionals must be alert to patients with septic shock and
acute respiratory distress syndrome who are being treated with
rapid fluid administration. This is because the conservative
strategy, studied in 1000 patients with acute respiratory distress
syndrome, all intubated, has been shown to be more beneficial
in terms of more ventilator-free days and more days out of the
intensive care unit (National Heart, Lung, and Blood Institute
Acute Respiratory Distress Syndrome (ARDS) Clinical Trials
Network, 2006).
With regard to the type of fluid therapy to be used, the
data are more consistent. In fact, in septic shock, resuscitation
with balanced crystalloids or albumin, compared with other
fluids, seems to be associated with lower mortality (Rochwerg
et al, 2014). The most commonly used crystalloid is normal
saline. However, compared with balanced crystalloids, it induces
hyperchloraemic metabolic acidosis, due to its high chloride
content (Rochwerg et al, 2014; Côrrea et al, 2015), impairs
smooth-muscle contractility, and decreases blood flow to the
glomerulus (Rochwerg et al, 2014). Dilutionary coagulopathy
and impaired immune response have also been described
(Côrrea et al, 2015). According to Rochwerg et al (2014) the
low mortality with the administration of balanced crystalloids
in contrast with normal saline is because balanced fluids more
closely resemble the homeostatic composition of human body
© 2018 MA Healthcare Ltd
fluids. A study reported by Corrêa et al (2015) showed that
resuscitation with balanced fluids reduced the risk of hospital
death, compared with unbalanced ones.
Albumin has been frequently used as a volume expander
for patients in a critical condition. Studies have proved the
British Journal of Nursing, 2018, Vol 27, No 8
Downloaded from magonlinelibrary.com by 131.172.036.029 on April 24, 2018.

benefits of its use in the field of septic shock, namely improved
survival (Rastegar, 2015). Data from Rochwerg et al (2014)
suggested similar mortality with administration of crystalloids
or of albumin in the context of septic shock. In terms of the
subsequent need for renal replacement therapy, crystalloids
solutions and albumin also produced similar results (Rochwerg
et al, 2015). However, compared with crystalloids, albumin has a
higher cost, and increased risk of allergic effects and transmission
of microorganisms (Corrêa et al, 2015).
Evidence has shown that crystalloid solutions are the
preferred choice in septic shock, and albumin can be used as
an alternative to large volume needs in the early phase of shock
resuscitation, according to Corrêa et al (2015). Rochwerg et al
(2014) suggested that albumin ‘may be a reasonable alternative
to other resuscitation fluids’.The fact that human albumin is
expensive and a limited resource has led to the development
of semisynthetic colloid solutions such as starches (Semler and
Rice, 2016). However, as far as starches are concerned, the
consensus seems to be that they are inferior alternatives to
balanced crystalloids and albumin (Rochwerg et al, 2014). In
fact, the most recent literature studied did not corroborate
the use of starches in resuscitation of septic shock (Corrêa
et al, 2015). In this context, Rochwerg et al (2015) reported
that resuscitation with crystalloids reduces the need for renal
replacement therapy when compared with starches.
Limitations of the review
It should be noted that the lack of data related to cardiogenic
shock was due to the application of the inclusion and exclusion
criteria in the present literature review. Thus, the exploration
of the theme in this type of shock is lacking.
Conclusion
Despite the importance and frequency of fluid therapy
administration in shock resuscitation, the amount and type
of fluids to be administered in each type of shock remains a
topic of discussion.
Concerning the amount of fluids to be administered in
haemorrhagic shock and, more specifically, the type of approach
to be taken, the evidence shows that hypotensive resuscitation
is the most appropriate approach. With regard to septic shock,
this question remains. However, the scientific community are
starting to suggest that a conservative fluid therapy approach
should be used in septic shock, although more research is needed.
Regarding the type of fluids to be administered, there seems
CPD reflective questions
© 2018 MA Healthcare Ltd
■■ Reflect on the implications of the results of this review on nursing practice
■■ How could these findings be incorporated into clinical practice?
■■ Consider researching this theme in the cardiogenic shock context
British Journal of Nursing, 2018, Vol 27, No 8453
RESUSCITATION
KEY POINTS
■■ The goal in shock treatment is the preservation and the improvement of
tissue perfusion
■■ Fluid therapy promotes an increase in intravascular volume, preload and
improvement of cardiac contractility and output, in order to optimise tissue
perfusion
■■ Keeping post-traumatic patients relatively hypotensive or restricting the
administration of crystalloids prevents respiratory failure, loss of plasma
and red blood cells
■■ The administration of fresh whole blood is referred to as the fluid therapy
of choice in haemorrhagic shock
■■ There seems to be an awakening of the scientific community to the idea of
treating septic shock with a conservative fluid therapy approach
■■ Evidence has shown that crystalloid solutions are the preferred choice in
septic shock, and albumin can be used as an alternative to large volume
needs in the early phase of shock resuscitation
to be consensus that blood is the best choice for resuscitation
of haemorrhagic shock, and it is agreed that administration of
crystalloids (balanced, preferably) is the fluid of choice in the
resuscitation of patients in septic shock. Increasing evidence
places albumin as an alternative to crystalloid solution.  BJN
Declaration of interest: none
Baker BL, Powell D, Riesberg J, Keenan S. Prolonged Field Care Working Group
fluid therapy recommendations. J Spec Oper Med. 2016;16(1):112–117
Brown JB, Cohen MJ, Minei JP et al for Inflammation and the Host Response
to Injury Investigators. Pretrauma center red blood cell transfusion is
associated with reduced mortality and coagulopathy in severely injured
patients with blunt trauma. Ann Surg. 2015;261(5):997-1005. https://doi.
org/10.1097/SLA.0000000000000674.
Butler FK, Holcomb JB, Schreiber MA et al. Fluid resuscitation for
hemorrhagic shock in tactical combat casualty care: TCCC Guidelines
change 1401—2 June 2014. J Spec Oper Med. 2014;14(3):13–38
Chen C, Kollef MH. Conservative fluid therapy in septic shock: an example of
targeted therapeutic minimization. Crit Care. 2014; 18(4):481. https://doi.
org/10.1186/s13054-014-0481-5
Corrêa TD, Rocha LL, Pessoa CM, Silva E, de Assuncao MS. Fluidoterapia para
a ressuscitação no choque séptico: qual tipo de fluido deve ser utilizado?
[Fluid therapy for septic shock resuscitation: which fluid should be used?]
Einstein (Sao Paulo). 2015; 13(3):462-8. https://doi.org/10.1590/S1679-
45082015RW3273
Dellinger RP1, Levy MM, Rhodes A et al for Surviving Sepsis Campaign
Guidelines Committee including the Pediatric Subgroup. Surviving sepsis
campaign: international guidelines for management of severe sepsis and
septic shock: 2012. Crit Care Med. 2013; 41(2):580-637. https://doi.
org/10.1097/CCM.0b013e31827e83af.
Downloaded from magonlinelibrary.com by 131.172.036.029 on April 24, 2018.
 Frazee E, Kashani K. Fluid management for critically ill patients: a review of
the current state of fluid therapy in the intensive care unit. Kidney Dis
(Basel). 2016; 2(2):64-71. https://doi.org/10.1159/000446265
Howard PK, Steinmann RA. Enfermagem de Urgência: da Teoria à Prática
[Portuguese translation of ‘Sheehy’s Emergency Nursing: Principles and
Practice]. 6th edn. Loures: Lusociência; 2010
Mattox KL. The ebb and flow of fluid (as in resuscitation). Eur J Trauma Emerg
Surg. 2015; 41(2):119-127. https://doi.org/10.1007/s00068-014-0437-0
Melnyk BM, Fineout-Overholt E, eds. Evidence-based practice in nursing
& healthcare: a guide to best practice. 1st edn. Philadelphia: Lippincot
Williams & Wilkins; 2005
Monahan F, Sands J, Neighbors M, Marek J, Green-Nigro C. Phipps:
Enfermagem Médico-Cirúrgica: Perspectivas de Saúde e Doença
[Portuguese translation of Phipps’ medical-surgical nursing: health and
illness perspectives]. 8th edn. Loures: Lusodidacta; 2010
National Heart, Lung, and Blood Institute Acute Respiratory Distress
Syndrome (ARDS) Clinical Trials Network. Comparison of two
fluid-management strategies in acute lung injury. N Engl J Med. 2006;
354(24):2564-75. https://doi.org/10.1056/NEJMoa062200
Polderman KH,Varon J. Do not drown the patient: appropriate fluid
management in critical illness. Am J Emerg Med. 2015; 33(3):448–450.
https://doi.org/10.1016/j.ajem.2015.01.051
Rastegar A. Rational fluid therapy for sepsis and septic shock; what do
recent studies tell us? Arch Iran Med. 2015; 18(5):308-13. https://doi.
org/0151805/AIM.009
Reddy S, Weinberg L,Young P. Crystalloid fluid therapy. Crit Care. 2016;
20:59. https://doi.org/10.1186/s13054-016-1217-5
Rochwerg B, Alhazzani W, Sindi A et al; Fluids in Sepsis and Septic Shock
Group. Fluid resuscitation in sepsis: a systematic review and network meta-
analysis. Ann Intern Med. 2014; 161(5):347-355. https://doi.org/10.7326/
M14-0178
Rochwerg B, Alhazzani W, Gibson A et al; FISSH Group (Fluids in Sepsis
and Septic Shock). Fluid type and the use of renal replacement therapy in
sepsis: a systematic review and network meta-analysis. Intensive Care Med.
2015; 41(9):1561–1571. https://doi.org/10.1007/s00134-015-3794-1
Semler MW, Rice TW. Sepsis resuscitation: fluid choice and dose. Clin Chest
Med. 2016; 37(2):241–250. https://doi.org/10.1016/j.ccm.2016.01.007
Urden LD, Stacy KM, Lough ME. Thelan’s: Enfermagem de Cuidados
Intensivos—Diagnóstico e Intervenção [Portuguese translation of Thelan’s
critical care nursing—diagnosis and management]. 5th edn. Loures:
Lusodidacta; 2008
Urden LD, Stacy KM, Lough ME. Cuidados Intensivos de Enfermagem
[Portuguese translation of critical care nursing: diagnosis and management]
6th edn. Rio de Janeiro: Elsevier Editora; 2013

Community Matrons:
Caring for people with
long-term conditions
Community Matrons:
Caring for people with Sue Lillyman, Ann Saxon
long term conditions
• Includes reflections on case studies that
will assist other case managers to make
decisions in relation to care
• Text has been written in guidance with
government policy
• Written by leading authors and
educationalists

ISBN-13: 978-1-85642-373-1;
ISBN-10: 1-85642-373-5; 234 x 156 mm;
paperback; 85 pages; publication May 2008; £19.99

To order your copies please call

By Sue Lillyman
01722 716935
© 2018 MA Healthcare Ltd

and Ann Saxon

or visit www.quaybooks.co.uk

454 British Journal of Nursing, 2018, Vol 27, No 8

Downloaded from magonlinelibrary.com by 131.172.036.029 on April 24, 2018.