So here is the first in a series of mini-talks geared towards having us think about fluid resuscitation, which, for those in acute care of almost any type (ER, wards, ICU, anasthesia, surgery, etc…) is part of our daily routine. And that’s exactly what it shouldn’t be, routine. It should be carefully thought out and adapted to each individual clinical situation we’re facing.
So I’ve decided to approach this from a completely different angle, not looking at what we do, what’s available, and see what has been stacked up against what, etc, etc… Instead, I’ve decided to start the discussion from a completely theoretical standpoint and talking about something that doesn’t exist: The Ideal Resuscitation Fluid.
Please, let me know your thoughts!
(sorry the last 40 seconds were cut – now the “full” 5 minutes are up! apologies, I am techno-challenged!)
sorry Philippe, but I think this podcast is not complete, can you check it?
Thank you Marco, for some reason the last 40 seconds got cut!
what’s your opinion about the european suspension of marketing authorisations for all solutions containing hydroxyethyl starch? I have always loved a replacement fluid that does his job, rather than extravasating, and so I miss them a lot in at least a couple typical critical care scenarios…
Great point about a replacement fluid doing its job – seems like common sense but the worldwide routine is to use something that inherently is expected to leave the vascular space for the most part!
That being said, I do think that in septic patients, there is enough evidence to suggest that the synthetic starches have an association with renal dysfunction to avoid using them… There is also some data to suggest diffuse interstitial deposits which may have some long term effects. I have limited my use of them to chronic hemodialysis patients (who cares about the kidneys!) in shock.
Instead, I tend to use albumin (it’s SAFE!!!) and a limited amount of hypertonic saline (3% or 7.5%, depending which hospital I’m working in).
thanks for commenting!
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