Salt water drowning…not just an environmental accident! Annals of Intensive Care 2014. #FOAMed, #FOAMcc

I’ve had the pleasure of knowing Paul for a few years as he has lectured at CCUS Symposia several times, and he is one of the few people I know who combine expertise, experience and a willingness – no, a passion – to think outside the box, challenge dogma and push the envelope of acute care.

In this month’s issue of the Annals of Intensive Care, Paul put together a great synthesis on fluid resuscitation, both the type and the quantity. It isn’t necessarily the kind of paper that gives you a cookie-cutter recipe on what to do, but rather the kind of paper that I really, really like: one that gives you a proper lens through which to see an issue, and a way to re-examine your therapeutic decisions.


Tying in the type of fluid to the glycocalyx, the author leads us down the path of physiological resuscitation, which is currently not being performed.  There is certainly much, much more to come on the topic in the next few years, and we have to be ready to possibly radically change our practice. For the better.

So I think this paper should be a cornerstone for any resuscitationist, whether or not you actually agree with everything Paul says.  If you don’t, then do come up with a rationale to justify what you like to do, and perhaps teach us all something along the way. Preferably, this rationale should be physiological, and possibly evidence-based, and should not include any of the following catch parses:

“well, it’s what everyone does,” “this is what we do at (prestigious) University…” “I’ve been doing this for 20 years,” “They call it normal saline for a reason you know (dismissive chuckle),” and “there’s no randomized trial…”  and on and on.  When I hear that, time to close the discussion.

Enjoy the article!


PS for awesome talks by amazing speakers (including Paul Marik!), don’t forget to register for CCUS 2015!!! For more info: and register at!