MMUH ICU ED teaching sepsis
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Fluid resuscitation for septic shock has been controversial, as some studies have found it beneficial while others question if it is. The ARISE and PROMISE trials tested early goal-directed therapy (EGDT) protocols against usual care in sepsis patients. The trials found no difference in outcomes between the EGDT and usual care groups. While EGDT involved more fluid administration, the absolute difference was small at less than 1,000ml. Overall, outcomes seem to be improving for sepsis patients with fluids, antibiotics, and source control, suggesting that the key is paying attention to patients rather than complex protocols.
![goals
CVP
cardiac output
BP
lactate
[jones 2010]
ScvO2
[rivers 2001]](https://image.slidesharecdn.com/e5j71hforosnqhmgf7rq-signature-2b694201778422c70fcb1e679e7ab2a61d09106f5f3f17096eecf9f1a93f7c8a-poli-140802101918-phpapp01/85/MMUH-ICU-ED-teaching-sepsis-7-320.jpg)
MMUH ICU ED teaching sepsis
- 1. sepsis
- 2. wheres the controversy 鍖u庄糸壊 goals
- 3. 鍖u庄糸壊
- 4. give more give less 鍖u庄糸壊
- 5. give exactly the amount of 鍖uid that they need and not a drop more
- 6. It is time to go back to basics and challenge our entrenched assumption that 鍖uid resuscitation is bene鍖cial for people in septic shock, rather than continue to argue over which 鍖uid works best.
- 10. the details multi centre RCT blinded assessors but not patients or docs early in the sepsis course had to get a decent bolus of 鍖u庄糸壊 before they could get in powered with an assumption of 35-40% mortality
- 11. the interventions EGDT protocol protocol based on expert consensus usual care
- 12. the results 31 centers screening 12000 pts and got 1300 no difference in primary outcome difference in 鍖u庄糸壊 signi鍖cant but in reality <1000ml other differences are protocol related
- 13. rivers 2001 process 2014 kaukonen 2014
- 14. the bottom line we seem to be getting better at this 鍖u庄糸壊, antibiotics, source control... paying attention matters ≒keep it simple stupid