The pro/con debate now on fluid resuscitation in sepsis!! This one is going to be awesome @Fluid_Academy #CCC50 @Manu_Malbrain no questions which side I am on :) @iamyourgasman
Townsend: How did we get the 30 cc/kg of fluid resuscitation in sepsis? Limb ischemia was common in under resuscitated patients. guidelines @CritCareMed 2004 suggested that under resuscitation was a problem. EGDT: Rivers et al;Process/Promise/Arise SOC was similar to 30 cc/kg
#CCC50 Townsend is making the argument that we don’t deliver care reliably and in a Swiss cheese model despite all the efforts for providing EGDT, errors are made...@SCCMPresident @ogi_gajic @iceman_ex @ChrisCarrollMD So, that’s why we need guidelines, protocols...
#CCC50 Townsend: There is a suggestion of harm in sepsis studies with large amounts of fluid resuscitation @SCCM @Manu_Malbrain #SCCMSoME
#CCC50 @SCCM Townsend: Sepsis bundles improve mortality ncbi.nlm.nih.gov Even in renal failure and heart failure patients...initial resuscitation still needs to be robust (30cc/kg)
@Manu_Malbrain #CCC50 Con: 30 cc/kg Mortality didn’t change dramatically after the SSC in the US
@Manu_Malbrain @Fluid_Academy @SCCM #CCC50 30cc/kg in one hour! Fluid stewardship-fluid balance is what we need!
#CCC50 low pre-load doesn’t mean we give fluids...septic pts may need early pressors due to vasoplegia @Manu_Malbrain
#CCC50 @Manu_Malbrain R.O.S.E. Prevent second and third space loss of fluid.
@Manu_Malbrain @Fluid_Academy @SCCMPresident @SCCM #CCC50 Lots of harm from fluid overload...be mindful
#CCC50 @Fluid_Academy @SCCM @ThinkingCC VexUS and other cool ideas for measuring fluid overload. Try Furosemide Stress Test. Did you know about the PAL?
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