MMUH ICU ED teaching sepsis

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Prepared for a brief talk at our joint ICU ED meeting. References at emergencymedicineireland.com

Transcript of MMUH ICU ED teaching sepsis

  • sepsis
  • wheres the controversy uids goals
  • uids
  • give more give less uids
  • give exactly the amount of uid that they need and not a drop more
  • It is time to go back to basics and challenge our entrenched assumption that uid resuscitation is benecial for people in septic shock, rather than continue to argue over which uid works best.
  • goals CVP cardiac output BP lactate [jones 2010] ScvO2 [rivers 2001]
  • ARISE PROMISE PROCESS
  • the details multi centre RCT blinded assessors but not patients or docs early in the sepsis course had to get a decent bolus of uids before they could get in powered with an assumption of 35-40% mortality
  • the interventions EGDT protocol protocol based on expert consensus usual care
  • the results 31 centers screening 12000 pts and got 1300 no difference in primary outcome difference in uids signicant but in reality