Tuesday, February 4, 2020

Fluid administration for CoV

PulmCrit (EMCrit)
PulmCrit - February 4, 2020 - By Josh Farkas
...An aggressive fluid resuscitation strategy in viral pneumonia is especially misguided. The primary life-threat facing these patients is ARDS (not hypoperfusion, and certainly not hypovolemia). Perfusion can generally be easily maintained with early administration of low-dose vasopressors and a conservative fluid strategy if necessary (although most patients with viral pneumonia have adequate perfusion to begin with). Notably, if hyperlactatemia is being driven by dyspnea causing sympathetic activation, this will only be exacerbated by fluid (which will worsen the respiratory failure)..." 
Summary The Bullet:
  • The Surviving Sepsis Campaign has recommended an aggressive fluid-first resuscitation strategy, despite mounting evidence that fluid boluses are dangerous and usually don’t cause sustained clinical benefit.
  • The Surviving Sepsis guidelines have been applied to coronavirus. In the context of viral pneumonia, large-volume fluid resuscitation may be particularly misguided (since the primary life-threat facing these patients is ARDS).
  • In the event of a pandemic of viral pneumonia, any treatment strategy which increases the number of ventilated patients could exhaust available ICU beds (even in well-resourced countries).