Phil and Terry, Am I off base here?
To me, and the clinicians at our institution, it is often not so much the volume, but the rate of infusion and how promptly to deliver the volume that is the controversy. And there is a very active debate at our institution on this. I suggest that 999 ml/kg is largely an inadequate rate. Our surgical intensivists totally support boluses administered by pressure bag and at a minimum wide open going in fast. However, many of our medical intensivists and nurses seem to believe that 999 ml/hr is acceptable and even ideal. It makes sense to me that sometimes 999 is ok, sometimes, but often it is inadequate and puts the patient at risk for remaining in a state of hypo perfusion. And even if fluid overload is a concern rapid bolus, with assessment after each is in order in septic shock and severe sepsis. g George Kramer, PhD UTMB OvidSP Results<message:%[email protected]%3E> From: <Dellinger>, Phil <[email protected]<mailto:[email protected]>> Date: Monday, October 28, 2013 10:54 AM To: Hesham Hassaballa <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Initial Fluid Bolus Probably the best thing to do. And definitely simpler than trying to figure out a more precise fluid load estimate. I addressed this issue with the primary investigators and research coordinators for the EUPHRATES trial(for which I am the PI for the international trial). We are looking at endotoxin removal with hemoperfusion in patients with septic shock identified to have high endotoxin activity. One of the entry criteria, which also includes a certain level of vasopressor support, is 30 ml/kg actual body weight of crystalloid(or colloid equivalent) fluid resuscitation. “From a purist standpoint, fluid bolus in obese septic shock patients should be somewhat less per kg than in someone who is normal body habitus since the intravascular volume expands at a somewhat lower % as body weight increases in the obese patient. However no one has ever used, in septic shock research trials, formulas that are available but not well validated to adjust for blood volume in the obese patient..” From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Hesham Hassaballa Sent: Friday, October 25, 2013 9:33 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Initial Fluid Bolus I'm using actual body weight, and it works out very well. I think if we use ideal body weight, it will under resuscitate the patient. Hesham A. Hassaballa, MD Program Medical Director Critical Care Rush-Copley Medical Center 2000 Ogden Avenue Aurora, IL 60504 Phone: (331) 454-6572 ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]<mailto:[email protected]>. ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]<mailto:[email protected]>. **************************************************************** This communication, including attachments, may contain information that is confidential. It constitutes non-public information intended to be conveyed only to the designated recipient(s). If the reader or recipient of this communication is not the intended recipient, employee, or agent of the intended recipient who is responsible for delivering it to the intended recipient, or you believe that you have received this communication in error, please notify the sender immediately by return e-mail or telephone and promptly delete this e-mail, including attachments without reading them or saving them in any manner. The unauthorized use, dissemination, distribution, or reproduction of this e-mail, including attachments, is prohibited and may be unlawful.
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