Revisiting our beliefs about Fluid Resuscitation: An N=1 Podcast. #FOAMed, #FOAMcc

So if you keep abreast of the fluid literature, you’ll note that more and more logical voices are bringing up very, very valid points against the powerful cultural backdrop of aggressive fluid resuscitation in various pathologies. Paul Marik’s recent publication, a great SMACC 2013 lecture by John Myburgh, not to mention several studies and analyses (VISEP, SOAP) illustrating consequences of overzealous fluid resuscitation. On the other side of the fence, you have the guidelines of various associations proclaiming loudly that fluids are “critically important” that there is a need to be “aggressive” and “generous.”  However, scratch a little beneath the surface and find…very little besides opinion and history. Zip. Nothing.

So my aim isn’t to make anyone stop giving fluids, but instead to treat fluids as any other therapy. Carefully given and assessed rather than in hyped-up frenzy.

I invite every physician reading or listening to, for a few minutes, put pre-concieved notions aside and approach the problem from a neutral and educated point of view, and come to your own conclusion, as unbiased as possible.

So here is my little podcast.

 

cheers

 

Philippe

 

ps just as I was uploading, checked my twitter and noted a great addition to the body of analysis by Josh Farkas, check it out:

http://www.pulmcrit.org/2014/08/the-myth-of-large-volume-resuscitation.html?m=1

fluid resuscitation: a physiological approach – an N=1 podcast, #FOAMed, #FOAMcc

This is my approach to fluid resuscitation – sorry for the lack of precision which, to me, is actually key.  It would be against the N=1 principle to give out a recipe…but here’s a way to think about it:

Sorry the last bit cut off – my iphone can only email an 8 minute audio clip! Which I wasn’t aware of until today.  Anyway all that was lost at the end was “thanks for listening and I’d really like to hear comments and others’ practices!”

And here’s a disclaimer:  I don’t think this is the be-all and end-all. My resuscitation is a work in progress, both in terms of new fluids coming up, and in terms of identifying subgroups or individuals who would benefit from a different approach, so I’m definitely eager to hear from anyone who does things differently – but physiologically!

Please see Dr. John Myburgh’s excellent review on fluid resus in NEJM sep 26th issue!

Oh and here’s the diagram!

Physiological Fluids

thanks!

Philippe