Abstract

Hypovolemic shock is a life-threatening condition in critically ill patients resulting from significant fluid loss and inadequate tissue perfusion. Optimal fluid resuscitation strategies are debated, with crystalloids, colloids, hypertonic solutions, and limited fluid resuscitation protocols all proposed as interventions. This systematic review evaluated evidence on fluid resuscitation approaches in hypovolemic shock to determine their effects on clinical outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide lines, a literature search was conducted in PubMed, Scopus, and Web of Science from 2012 to 2025. Included studies involved adult human patients with hypovolemic shock and evaluated fluid resuscitation strategies with reported clinical outcomes. Data extraction and quality assessment were performed independently by two reviewers. A qualitative synthesis was conducted due to heterogeneity in study designs and outcomes. Eight studies were included, including randomized clinical trials and subgroup analyses. Limited fluid resuscitation strategies were associated with lower mortality, improved lactate clearance, and reduced transfusion volume compared to traditional aggressive resuscitation. Hypertonic saline showed favorable effects on mean arterial pressure and inflammation markers with lower fluid requirements, at 3% concentration. Colloid use did not improve 28-day mortality but was associated with better 90-day outcomes and fewer ventilator days in selected populations. Centhaquine showed good results in improving perfusion and reducing vasopressor dependency and mortality. This study supported the use of limited fluid resuscitation and hypertonic saline as effective strategies in hypovolemic shock, in trauma, and hemorrhagic cases. While colloids offer some long-term benefits, their routine use remains controversial.

Key words: Hypovolemic shock, fluid resuscitation, crystalloids, critically ill patients, review