Date post: | 21-Aug-2014 |
Category: |
Health & Medicine |
Upload: | andrew-neill |
View: | 897 times |
Download: | 14 times |
sepsis
where’s the controversy
fluids goals
fluids
give more give less
fluids
“give exactly the amount of fluid that they need and not a drop more”
“It is time to go back to basics and challenge our entrenched assumption that fluid resuscitation is beneficial for people in septic shock, rather than continue to argue over which fluid works best.”
goals
CVP
cardiac output
BP
lactate[jones 2010]
ScvO2[rivers 2001]
ARISE PROMISE PROCESS
the details
•multi centre•RCT•blinded assessors but not patients or docs•early in the sepsis course•had to get a decent bolus of fluids before they could get in•powered with an assumption of 35-40% mortality
the interventions
EGDT protocol
protocol based on expert consensus
usual care
the results
•31 centers screening 12000 pts and got 1300•no difference in primary outcome•difference in fluids ‘significant’ but in reality <1000ml•other differences are protocol related
rivers 2001
process 2014
kaukonen 2014
the bottom line
•we seem to be getting better at this•fluids, antibiotics, source control...•paying attention matters•“keep it simple stupid”