An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …
Continue reading More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)
A paper regarding to acute pancreatitis was published in the New England Journal of Medicine on 15 September of 2022. It is titled "aggressive or moderate fluid resuscitation and acute pancreatitis". Hat tips to the authors. I would tell you to read this article for yourself but, unfortunately, it is hidden behind the pay wall …
Continue reading Resuscitation in Acute Pancreatitis: IV Fluids
If you have come onto this site, I would first of all like to thank you for attending one of my lectures. I believe that anyone who speaks has the potential of accidentally misquoting or misinterpreting a study. Therefore, I present to you the citations of my Crystalloid Journey work so that you could read …
In patients who need IV fluids, we can either provide "normal saline" or balanced salt solutions.Balanced salt solutions include Lactated Ringer's and Plasmalyte.There have been several trials trying to answer this question. The data hasn't been as rock solid as we'd like to convince our biases.The BaSICS trial is a recent landmark trial.As always, I …
Continue reading BaSICS Trial: Plasmalyte vs. 0.9% NaCl in the Critically Ill
When patients present to the ED in DKA, should we resuscitate them with 0.9% sodium chloride (saline) or balanced salt solutions such as plasma-lyte or lactated ringers?Many DKA order sets use 0.9% sodium chloride "aka normal saline" as their initial fluid of choice.We know these patients are dry when they arrive to the ED.They need …
Continue reading Saline or Lactated Ringers/Plasma-lyte for DKA Resuscitation?
Albumin is a colloid that is frequently used in the resuscitation of critically ill patients. Amongst those indications we see it used in sepsis and very frequently in the cardiac surgery space. What prompted me to write this post was an article by Joannidis et al. published in Intensive Care Medicine last month. In that …
Continue reading Albumin in Resuscitation: Sepsis, Cardiac Surgery, & Other Indications
To begin, I will disclose my bias. I wanted plasma-lyte to outperform 0.9% NaCl, also called normal saline in critically ill patients. It turns out that after the publication of the PLUS trial, I have to chill the heck out to an extent. On this blog as well as social media, I have scrutinized 0.9% …
Continue reading Plasma-lyte vs. Saline (0.9% NaCl): The PLUS Trial was a Negative Study
A common scenario that occurs daily, heck even perhaps hourly, in most emergency departments or intensive care units around the world including providing patient with IV fluids rapidly via fluid bolus to resuscitate hypotensive patients or those who are in shock. In order to mitigate said hypotension/shock, the most common response by clinicians is to …
Continue reading Fluid Bolus in Resuscitation: Pressure Bag vs. 999ml/hr on the IV Pump
This page is a work in progress as a IV Fluid guide and will continue to grow throughout the years. Last updated on 3/3/22. This page is quite the mess right now if I am being honest. I will get it together at some point. Just many projects running simultaneously. Table of Contents for the …
Continue reading The IV Fluid Guide: 0.9% NaCl, Ringers Lactate, Plasmalyte & Albumin
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!