MMUH ICU ED teaching sepsis

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Prepared for a brief talk at our joint ICU ED meeting. References at emergencymedicineireland.com

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MMUH ICU ED teaching sepsis

  1. 1. sepsis
  2. 2. where’s the controversy fluids goals
  3. 3. fluids
  4. 4. give more give less fluids
  5. 5. “give exactly the amount of fluid that they need and not a drop more”
  6. 6. “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.”
  7. 7. goals CVP cardiac output BP lactate [jones 2010] ScvO2 [rivers 2001]
  8. 8. ARISE PROMISE PROCESS
  9. 9. 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
  10. 10. the interventions EGDT protocol protocol based on expert consensus usual care
  11. 11. 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
  12. 12. rivers 2001 process 2014 kaukonen 2014
  13. 13. the bottom line •we seem to be getting better at this •fluids, antibiotics, source control... •paying attention matters •“keep it simple stupid”

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