classic trial

CLASSIC Trial: IV Fluids for Septic Shock in the ICU

We often overload our septic shock patients with IV fluids.The CLASSIC trial looked at the fluids we give in the ICU after resuscitation in the ED.This is not medical advice. Read the article for yourself.Almost 1600 patients were enrolled in either the standard or restrictive IV fluid group.Before arriving to the ICU, these patients received …

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fluid bolus 2

Fluid Bolus in Resuscitation: Pressure Bag vs. 999ml/hr on the IV Pump

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 …

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pulse pressure variation

Pulse Pressure Variation (PPV) for Fluid/Volume Responsiveness

There are numerous methodologies that we can utilize to determine fluid responsiveness in our critically ill patients in the emergency department or in the intensive care unit. In this post, I will be taking a deep dive into pulse pressure variation, PPV as the shorthand. For details about the other methods for determining fluid responsiveness, …

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end-expiratory occlusion

End-Expiratory Occlusion for Fluid/Volume Responsiveness

What is end-expiratory occlusion testing? It is a method we can use at the bedside to determine whether a patient is fluid responsive. We have actually known about this since 2009 when Monnet et al. explored this concept in a not-free article. The full description of the heart-lung interaction that allows this to work is …

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Resuscitation and Volume/fluid Responsiveness

Resuscitation in Sepsis using Fluid/Volume Responsiveness

This post is a work in progress blog post for my lecture titled "Resuscitation and Fluid Responsiveness". In the lecture, I discuss fluid resuscitation in sepsis in volume responsiveness. After all, only 50% of critically ill patients are fluid responsive and 66% of patients in septic shock are volume overloaded on hospital day 1 (Douglas, …

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stroke volume variation

Stroke Volume Variation (SVV): Predicting Fluid Responsiveness

I have covered many things resuscitation and fluid responsiveness thus far on this page. Fluid responsiveness has been defined as a patient given either a certain amount of fluid or a passive leg raise to assess how that will increase the cardiac output/index or stroke volume. This post will be about stroke volume variation (SVV) …

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IV Fluid Overload: Don’t Drown your Patients!

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 …

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Central Venous Pressure (CVP) in the ICU: Does it predict fluid responsiveness? Nope.

Dinosaurs still roam the earth, I know this. They are slowly and surely retiring, though. I trained in the days where Manny Rivers and the Surviving Sepsis Campaigns pushed for Early-Goal Directed Therapy were king. Hey, there was a reason why it was so successful, EGDT decreased in-hospital mortality from 46.5% to 30.5% in that …

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scvo2 svo2

SvO2 and ScvO2 to Guide Resuscitation in Septic and Cardiogenic Shock

You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Here, I explain what they are. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're …

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Passive Leg Raising + Stroke Volume for Fluid/Volume Responsiveness

This post is regarding using passive leg raising and stroke volume to determine fluid responsiveness in patients who need resuscitation. Check out far more in depth data regarding all this HERE. Don't think that I'm anywhere close to being finished on discussing fluid resuscitation and when to stop, I think I could spend a whole …

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