No fluids ?. You have to be joking …….. Basic principles of care We may disagree about the type of fluids …. But limit them …… hypoperfused, blue edges, high lactate …. Sorry Give the fluids !. How much fluid should we give?.
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You have to be joking ……..
Basic principles of care
We may disagree about the type of fluids ….
But limit them …… hypoperfused, blue edges,
high lactate …. Sorry
Give the fluids !
How much fluid should we give?
It’s too vague!
Yet fluid resuscitation has a very powerful effect upon outcome
These monitors do alter fluid & vasopressor management
Mimoz O et al, Crit Care Med 1994
the paper looks at supranormal vs normal goals …
Nothing to with fluids per se ! Balogh Arch Surg 2003 138:637
ISS > 15 trauma patients well matched ISS 28±3 27 ± 2
Lactate 4.2±1 vs 3.9 ±1 Pre ITU fluids (blood and crystalloid similar)
2 treatment protocols : D02 > 600 or 500
In D02 > 600 ml.min/m2 compared to > 500 ml/min/m2
Higher C02 gap 16±2 vs 7± 1*
IAH 42 vs 20% * ACS 16 vs 8%*
Mortality 27 vs 11%*
More Ringers lactate given in > 600 grp
13.2 ± 2 vs 7± 1 L*
No difference in blood Tf - trend only
Protocol to Hb > 10 , Ringers to achieve PAOP 15
Pressors MAP > 65 mmHg
Lactate, BD , CI - all normalised at the same rates
So was this fluid needed ± is there an effect of the type of fluid
Should we be measuring COP in this group of patinets
r = 0.66
p = 0.003**
r = 0.59
p = 0.02