So here, Jon-Emile and I explore a topic I’ve posted about before (http://wp.me/p1avUV-bd) so I can see if a master physiologist agrees with my rationale (…not just my rationale but supported by a ton of literature many choose to overlook!).
Please visit http://www.heart-lung.org for Jon’s awesome physiology tutorials!
Love to hear listeners’ thoughts!
cheers
Philippe
thinking critical care 
Can we get the reference for the alpha-constrictors auto-bolusing ~ 2L ? Thanks.
What are the references this past year showing better outcomes with earlier pressors and less volume?
Thx
Hi Barry!
Thanks for reading and asking that question. The simple answer is, there are none.
Well designed resuscitation outcome studies are, at this point, minimal. I say this not to discredit the ones that have been done, but the inherent difficulty lies in the absence of specific patient data pertaining to resuscitation, notably their presentation volume status, the evolution and severity of their “leakiness” in the disease course, their cardiac function, both right and left, and their vascular reactivity. Without this, we invariably lump all the patients and their heterogeneity together and try to come up with a single answer. This simply does not make any sense, and so only interventions with radical impact (antibiotics? fluids vs no fluids at all? vasopressors vs none?) would result in solid data. The problem, and reason why this isn’t anyone’s fault, is the incredible complexity of such a study… Hence, I think the best we can do is look at the available studies and try to see trends and patterns, assess our patients, and see which interventions are possible, make sense physiologically, and may have some support by the literature. More importantly, using monitoring to look for response to therapy is good – but even then flawed because we don’t truly have good resuscitation goals, physiologically speaking. That will be the topic of my next discussion with Jon!
cheers!
Philippe