Gavin raises his legs!!

Tweet The assessment of fluid responsiveness in haemodynamically unstable patients. My good friend Gavin Denton (@dentongavin) has once again surpassed himself in analysing some of the evidence for the passive leg raise. Over to you Gav (I think I love him….ssshhhh).   Background. Clinical examination and findings have long been used to guide fluid resuscitation. […]

When to transfuse?

Tweet The Gist: “Permissive _____” is becoming increasing popular in medicine-blood glucose, blood pressure, and oxygen saturation. Hemoglobin is similar, but common refrains may be heard “well, he looks puny, let’s give him a couple of units.” Currently, the best evidence suggests that transfusion of packed red blood cells (PRBCs) should be considered in most […]

The ALBIOS Trial: Albumin in Severe Sepsis?

Tweet The New England Journal of Medicine. 2014. 370(15):1402-141 Among patients with severe sepsis or septic shock, does administration of albumin 20% solution to maintain serum albumin level ≥3 g/dL reduce all-cause mortality at 28 days when compared to no albumin? Multi centre, open label. randomised trial. Inclusion criteria Suspected or proven infection in one […]

Colloids versus crystalloids for fluid resuscitation in critically ill patients.

Tweet Trauma, burns or surgery can cause people to lose large amounts of blood. Fluid replacement, giving fluids intravenously (into a vein) to replace lost blood, is used to try to maintain blood pressure and reduce the risk of dying. Blood products, non-blood products or combinations are used, including colloid or crystalloid solutions. Colloids are […]

NOT Chloride!…(most of the time…)

Tweet Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M JAMA 2012 Does a chloride restrictive approach fluid replacement therapy reduce the risk of acute kidney injury in the critically ill patient? A prospective, open label, before-and-after pilot study. A […]

The Reliability & Validity of PLR to Assess Fluid Responsiveness in Spontaneous Breathing ED Pt’s

Tweet Assessment of fluid responsiveness (FR) is used to guide volume resuscitation; however, the reliability and accuracy of the passive leg raise (PLR) and fluid bolus (BOLUS) techniques are undefined in the emergency department (ED) setting…..link here

Choice of Fluid- John Myburgh Summary.

Tweet Fluid resuscitation in acute medicine: what is the current situation?  Journal of internal medicine (Accepted Article) Professor John A Myburgh AO, is Director of the Division of Critical Care and Trauma at the George Institute for Global Health, Professor of Critical Care at the Faculty of Medicine, University of New South Wales and senior […]

ARISE Trial- Early Goal Directed Therapy Is Not The Gold Standard…

Tweet Goal-Directed Resuscitation for Patients with Early Septic Shock The ARISE Investigators and the ANZICS Clinical Trials Group   Emmanuel Rivers trial found a big difference in 90 day mortality when using early goal directed therapy and as a consequence the Surviving Sepsis Guidelines have advocated the use of this algorithm.  The recent PROCESS trial […]

CCP Podcast 014: How Much Fluid?

Podcast: Play in new window | DownloadSubscribe: Apple Podcasts | Android | RSSTweet I made contact with Dr Segun Olunsanya via Twitter to discuss some of the issues around the fluid management of the sick patient. He in turn persuaded a couple of others involved in ITU. This has led to this fascinating discussion around […]

ProCESS- Get rid of the central line?

Tweet And the debate goes on! How much fluid should we give our septic patients? The results from the ProCESS trial are out and I am still not sure that we have an answer. So I listened to one of my go to guys to help me understand…..Scott Weingart. The Method Patients enrolled were those […]

End-tidal Carbon Dioxide as a Surrogate of Cardiac Output

Tweet The study entitled “End-tidal carbon dioxide (EtCO2) is better than arterial pressure for predicting volume responsiveness by the passive leg raising test” published in Intensive Care Medicine has garnered much attention from the field in recent months (see article reviewfrom ESICM NEXT). This attention is due to its probable impact on clinical practice: This […]

Mariks’ Deadly Trio!

Tweet Iatrogenic salt water drowning and the hazards of a high central venous pressure. Marik Annals of Intensive Care 2014, 4:21   Paul Marik has been investigating the effects of fluid on the septic patient over the years, publishing several important papers in the process. Does Central Venous Pressure Predict Fluid Responsiveness? CHEST 2008 Heamodynamic parameters […]

Importance of the Infusion Rate for the Plasma Expanding Effect of 5% Albumin, 6% HES 130/0.4, 4% Gelatin, and 0.9% NaCl in the Septic Rat

Tweet The study showed that the PV expansion by a colloid was greater when given at a slow than at a fast infusion rate, an effect more pronounced for albumin. This difference was not seen for NaCl. The PV-expanding effect was poor for NaCl and better for albumin than for the other colloids….link here