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martes, 17 de diciembre de 2013

Fluidos en sepsis

EMergucate
EMergucate December 17, 2013 - By Anad Senthi - FOAM Eye-Catchers 4

"Recently Emcrit released a paradigm shifting lecture by Dr Paul Marik on fluids in sepsis that builds on some of the theme’s of Prof Myburgh’s talk. Not long after, Scott Weingart released his response to Dr Marik’s lecture.
All 3 talks are well worth listening to in full. However I’ve summarised some of the key concepts below as well as the FEAST study which is a landmark study discussed in both talks:

  • Prof Myburgh´s Lecture
  • Dr Marik´s Lecture
  • Dr Scott Weingart´s Response to Marik
  • The FEAST Study
In summary there seems to be a controversial paradigm shift away from our fluid liberal approach to sepsis management where we tend to resuscitate patients to short term haemodynamic parameters such as blood pressure, as long as they are fluid tolerant, towards a more cautious approach giving smaller volumes at slower rates to those who we predict to be fluid responsive based on cardiac output. There is an absence of high quality evidence supporting our aggressive approach to fluid resuscitation in sepsis and the emerging evidence questions this approach. Our focus on short term haemodynamics may be misguided as despite improvements with fluid therapy this does not necessarily correlate with the patient’s outcome and may possibly adversely affect it.
In short, we should extend the same due care and consideration when administering IV fluids as we do when we administer any other medication."

http://www.emergucate.com/2013/12/17/foam-eye-catchers-4/
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Resuscitation Medicine Education -  December 17, 2013 - By Cliff
"There’s so much debate on which components of Early Goal Directed Therapy in sepsis really make a difference. The good news is that three randomised controlled trials in the UK, Australasia, and North America, aim to answer the question, and the study design from the outset has been a collaboration that will allow the results to be pooled. ProMISe is taking place in the UK, ProCESS in the US, and ARISE in Australasia."

http://resus.me/sepsis-research-lets-get-some-answers/