Re: [Sepsis Groups] NSS vs Albumin (UNCLASSIFIED)

Sat, 20 Apr 2013 08:42:00 -0700 

UNCLASSIFIED
info
 
Balanced versus chloride-rich solutions for fluid resuscitation in 
brain-injured patients: a randomized double-blind pilot 
study(blockedhttp://ccforum.com/content/pdf/cc12686.pdf) 
Roquilly A, Loutrel O, Cinotti R, Rosenczweig E, Flet L, Mahe P, Dumont R, 
Chupin A, Peneaux C, Lejus C, Blanloeil Y, Volteau C, Asehnoune K 
Critical Care 2013, 17:R77 (19 April 2013)
 
 
On 04/19/13, Thomas Morris wrote:
> Hi George
> 
> Thanks for that: my main feeling is that the ideal fluid to give in severe 
> sepsis/shock would presumably be plasma, or the exact consituents of that 
> which leak out of the capillaries. Clearly this is not going to be possible, 
> so, whilst it is important to ascertain which fluids are better (or least 
> futile, dare I suggest it) than others, what we clearly also need are better 
> adjunctive therapies for sepsis (ie. alongside antibiotics) to help switch 
> off the SIRS and capillary leak, rather than just focussing on which horses 
> are running away. Make any sense?
> 
> Two questions from me while we wait for an effective adjunctive treatment to 
> come out:
> 
> i) Are the lactate components of Ringers' or Hartmann's anything to worry 
> about?
> 
> ii) How much Normal Saline can we give before hyperchloraemic acidosis 
> becomes an issue.
> 
> Thanks very much indeed
> 
> Tom Morris
> Infectious Disease/General Medicine Registrar
> Leicester, UK
> 
> 
> On Fri, 19 Apr 2013 11:06:45 +0000
> "Kramer, George C." <[email protected]> wrote:
> >A perspective from a not so humble physiologist studying fluid resuscitation 
> >of shock.
> >
> >Large volumes of Normal Saline can contribute to hyperchoremic acidosis and 
> >renal dysfunction. Normal saline is not normal.
> >
> >Lactated Ringers or better Plasmalye are electrolyte balanced. plasmalyte is 
> >isotonic. Normal saline is hypertonic (maybe ok, except for the chloride), 
> >but LR is hypotonic, can contribute to cerebral edema. In large volumes.
> >
> >In small volumes or relatively 'healthy' patients these differences are not 
> >important.
> >
> >Albumin — best available evidence from mortality outcomes, is Albumin is not 
> >better and may be worst. However, when you need rapid boast to 
> >cardiovascular function it is superior. Many suggest that mortality outcomes 
> >is not the whole story. And the trial data is muddled. And the meta-analyses 
> >are flawed.
> >
> >The downside of albumin may be that it leaks into interstitial space some 
> >and holds water and long term is worst. Lung may be particularly concern. 
> >This is more likely when you have permeability leak and you have that big 
> >time with sepsis.
> >
> >These topics remain controversial by experts in fluid space and under 
> >appreciated and confusing to non experts.
> >
> >Best email for me is
> >[email protected]
> >
> >George C Kramer, PhD
> >Director, Resuscitation Research Lab
> >Professor, Dept. of Anesthesiology
> >301 University Blvd.
> >UTMB, Galveston, TX 77555-1102
> >
> >Office (Mary) 409-747-0077
> >Direct: 409-772-3969
> >Cell: 409-939-3040
> >Lab (Muzna) 409-772-6885
> >Fax: 409-772-8895
> >UTMB email: [email protected]
> >http://www.utmb.edu/rrl/
> >
> >
> >G
> >
> >
> >
> >
> >
> >From: 
> >"[email protected]<mailto:[email protected](javascript:main.compose()>"
> > 
> ><[email protected]<mailto:[email protected](javascript:main.compose()>>
> >Date: Wednesday, April 17, 2013 12:39 PM
> >To: 
> >"[email protected]<mailto:[email protected](javascript:main.compose()>"
> > 
> ><[email protected]<mailto:[email protected](javascript:main.compose()>>,
> > 
> >"[email protected]<mailto:[email protected](javascript:main.compose()>"
> > 
> ><[email protected]<mailto:[email protected](javascript:main.compose()>>
> >Subject: Re: [Sepsis Groups] NSS vs Albumin
> >
> >Usually we see NSS in ED and recently the Intensivists started adding 
> >Albumin to continued need for NSS boluses.
> >
> >From: 
> >[email protected]<mailto:[email protected](javascript:main.compose()>
> > 
> >[mailto:[email protected]](javascript:main.compose()
> > On Behalf Of Katzaman, Alecia
> >Sent: Monday, April 15, 2013 3:10 PM
> >To: 
> >'[email protected]<mailto:'[email protected](javascript:main.compose()>'
> >Subject: [Sepsis Groups] NSS vs Albumin
> >
> >What does everyone do in terms of fluid resuscitation – do you give NSS or 
> >Albumin? What do you do in the ED? DO you have a limit of NSS that is given 
> >before Albumin is given, or is provider specific?
> >
> >Alecia Katzaman, MSN, RN
> >Emergency Department Quality Improvement Coordinator
> >
> >[Description: Description: RHLogo_Email]
> > P.O. Box 16052
> > Reading, PA 19612-6052
> >
> >[email protected]<mailto:[email protected](javascript:main.compose()>
> >www.readinghealth.org<http://www.readinghealth.org/>
> >PHONE: 484-628-4810
> >
> >Advancing Health. Transforming Lives.
> >
> >
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