The 4 Phases of Fluid Therapy in Sepsis


  • Fluid therapy is an important component of sepsis therapy and may be administered during any phase of sepsis illness.
  • While hemodynamic benefits may occur during initial fluid therapy, excessive amounts can be deleterious.
  • Timing, rate and volume of fluid administration and removal vary based on the phase of critical illness.


  • Intravenous fluid therapy is an essential part of sepsis therapy.
  • Fluid therapy occurs in 4 phases of sepsis critical illness.
  • Each phase is associated with a separate clinical state of the patient.

1. RESUSCITATION PHASE – rapidly reverse hypoperfusion

  • Approximately 57% of sepsis patients will respond to fluids with an increase in stroke volume and cardiac output.
  • Fluid therapy should continue until the patients mean arterial pressure no longer increases with IV fluid administration
  • There are 3 methods of fluid administration (see Table below), with fluid bolus administration preferred

2. OPTIMIZATION PHASE – Attain perfusion to organs and tissues

3. STABILIZATION PHASE – Maintain homeostasis and resolve organ dysfunction

  • Few studies evaluate fluid therapy during the Optimization and Stabilization phases.
  • No difference in 90 day mortality with a restrictive vs standard fluid therapy management approach after initial resuscitation.

4. EVALUATION PHASE – Excrete excess accumulated fluids

  • Patients may require diuretics or kidney replacement therapy
  • The optimal rate and duration of kidney replacement therapy fluid removal in this phase is not known.
  • Slow or rapid kidney replacement may have higher mortality and longer duration of treatment than moderate rate flows.


  • Fluid therapy remains a mainstay for the treatment of the sepsis patient.
  • The total amount of fluid and rate of administration for proper resuscitation remains debated topics.
  • The 4 phases of fluid therapy represent a separate clinical status of the sepsis patient with its own considerations.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (, or video chat.