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Balanced Fluid Resuscitation for the Critically-Ill: the PLUS study mirrors the BaSICS

PulmCCM

What they did Adult patients admitted to one of 53 intensive care units in New Zealand or Australia between September 2017 and December 2020 were eligible. Patients were thus excluded if they had indications for a specific type of IV fluid resuscitation or if they had received more than 500 mL of IV fluid in the ICU.

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e.

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Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)

RebelEM

There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure. Though the initial recommendation for aggressive fluid resuscitation was not based on substantial evidence, clinicians have been slow to pivot away from this approach.

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Trauma Resuscitation Updates

RebelEM

Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2]

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Electrical injuries

Don't Forget the Bubbles

Judicious fluid resuscitation is critical; patients may become volume-deplete due to fluid loss/oedema secondary to burns. Deep tissue injuries may not be visible, and as muscle breaks down, it leads to myoglobinuria, rhabdomyolysis and renal failure. Pittman O, Toner H. Narayanan, K., and Marijon, E., Electrical injury.

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52 in 52 – #41: The CENSER Trial

EMDocs

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

So, fluid has been tried but has not got close to fixing the problem. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. The wide pulse pressure and transient response would suggest an afterload problem.

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