Facebook LinkedIn Twitter. What evidence do we have to answer some of these questions in man? Intensive Care Med 2009, 35: We now know that the answer in children in resource-poor countries is a resounding 'no'.
Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. When the search is narrowed to randomized controlled trials, however, the list rapidly shortens to 47 papers - and disappointment sets in when these studies are analyzed in detail, as only two papers remain that use more than physiological outcomes as end points [ 1 , 2 ].
To use an analogy: Finally, the only multicentre randomized controlled studies available were designed to address the type of fluids to be used for such resuscitation [ 1 , 2 ], not whether the fluids should have been given in the first place.
Perhaps the strongest driver to fluid bolus resuscitation in sepsis has been the association between a hyperdynamic cardiac output state and better outcome in patients with critical illness [ 24 ].
In the present article, we contend that the concept of large fluid bolus resuscitation in sepsis needs to be investigated further.
Moreover, it is a formal logical fallacy to reason that 'survivors have a hyperdynamic circulation; therefore, if a patient can be made to have a hyperdynamic circulation, he or she will survive'. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis.
His one great achievement is being the father of two amazing children. Abstract Resuscitation of septic patients by means of one or more fluid boluses is recommended by guidelines from multiple relevant organizations and as a component of surviving sepsis campaigns.
A critique of fluid bolus resuscitation in severe sepsis. Anaesth Intensive Care 2007, 35: This study found increased mortality in animals allocated to fixed higher volume resuscitation [ 12 ]. The Medicine Box Handy hints and tips to save both you and your patient…. Fluid therapy in resuscitated sepsis: