I'm glad we're not the only ones with woefully slow pumps! We make up for
it by using 2 or 3 infusion sites; for instance, 999 m/hr in each arm and
through a central line, so about 1L every 20 minutes.
Louis Landman, MD
-----Original Message-----
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Sent: Monday, November 04, 2013 5:50 PM
To: [email protected]
Subject: Sepsisgroups Digest, Vol 82, Issue 2
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Today's Topics:
1. Re: Initial Fluid Bolus (Hawkins, Denis)
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Message: 1
Date: Mon, 4 Nov 2013 22:50:17 +0000
From: "Hawkins, Denis" <[email protected]>
To: "'[email protected]'"
<[email protected]>, "'[email protected]'"
<[email protected]>
Cc: "'[email protected]'" <[email protected]>, "'[email protected]'"
<[email protected]>, "'[email protected]'"
<[email protected]>, "'[email protected]'"
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Subject: Re: [Sepsis Groups] Initial Fluid Bolus
Message-ID:
<1d03c7f613bcdd4eac466f6a435ddf2b013dc...@smesexcp014031.msnyuhealth.org>
Content-Type: text/plain; charset="utf-8"
Anyone have a good article to use as evidence for initial fluid bolus?
From: Hesham Hassaballa [mailto:[email protected]]
Sent: Sunday, November 03, 2013 03:32 PM
To: Kramer, George C. <[email protected]>
Cc: Mileski, William <[email protected]>;
[email protected] <[email protected]>;
Tillman, Melinda A. <[email protected]>; Pacheco, Luis D.
<[email protected]>; Whitehead, William E. <[email protected]>; Kinsky,
Michael P. <[email protected]>
Subject: Re: [Sepsis Groups] Initial Fluid Bolus
I completely agree with George. 999 mL/hr is WAY too slow. The problem is
the pumps can't go any faster, and many times the patients have poor IV
lines that can't take pressure bag boluses ( because many times we are
putting in the central line)
Hesham A. Hassaballa, MD
Program Medical Director
Critical Care
Rush-Copley Medical Center
2000 Ogden Avenue
Aurora, IL 60504
Phone: (331) 454-6572
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On Nov 3, 2013, at 8:08 AM, "Kramer, George C."
<[email protected]<mailto:[email protected]>> wrote:
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
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