How much fluid would Goldilocks give a septic shock patient? (audio lecture)

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Module 4: How much fluid would Goldilocks give a septic shock patient? (audio lecture)

In this audio lecture, Dr. Phillip Dellinger of Cooper University Healthcare in Camden, NJ, discusses fluid needs for patients in septic shock – how much to give and when to stop.

Figure/Literature Timestamps and References:

1:30 Figure B. Septic Shock Pre-Fluid Resuscitation. R Phillip Dellinger. Cardiovascular management of septic shock. Crit Care Med. 2003;31(3):946-955. DOI: 10.1097/01.CCM.0000057403.73299.A6

2:14 Andrew Rhodes,?Laura E Evans,?Waleed Alhazzani,?et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552. DOI: 10.1097/CCM.0000000000002255

2:46 ProCESS Investigators;?Donald M Yealy,?John A Kellum, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683-1693. DOI: 10.1056/NEJMoa1401602

3:21 ProCESS vs. ARISE trials

4:16 Figure 1. Four Stages of Volume Resuscitation Therapy. Erin Frazee,?Kianoush Kashani. Fluid management for critically ill patients: a review of the current state of fluid therapy in the intensive care unit. Kidney Dis (Basel). 2016;2(2):64-71. DOI: 10.1159/000446265

5:09 Figure A and B. Adjusted Survival Curves. John H Boyd,?Jason Forbes,?Taka-aki Nakada, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259-265.

7:10 Dialysis Machine Settings in ICU Patient.

7:27 Fluid resuscitation needs and hospital mortality. Claire V Murphy,?Garrett E Schramm,?Joshua A Doherty, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest. 2009;136(1):102-109. DOI: 10.1378/chest.08-2706

8:07 Starling Curve

9:30 Arterial Pressure Drives Tissue Perfusion

10:45 Martin W Dünser,?Jukka Takala,?Andreas Brunauer, et al. Re-thinking resuscitation: leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach. Crit Care. 2013 Oct 8;17(5):326. DOI: 10.1186/cc12727

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