100 episodes

The Resuscitation podcast delivers both short format quick updates on the latest resuscitation literature, as well as selected favorite lectures from the live conference.

Resuscitation Conference Podcas‪t‬ Resuscitation Conference

    • Science

The Resuscitation podcast delivers both short format quick updates on the latest resuscitation literature, as well as selected favorite lectures from the live conference.

    Episode 124: Does Timing of Epi in OHCA Make a Difference?

    Episode 124: Does Timing of Epi in OHCA Make a Difference?

    Episode 124: Does Timing of Epi in OHCA Make a Difference?

    Episode 123: An Update on Fluids in Neurocritically Ill Patients

    Episode 123: An Update on Fluids in Neurocritically Ill Patients

    Episode 123: An Update on Fluids in Neurocritically Ill Patients

    Episode 122 - Dex for Early Post-Intubation Sedation?

    Episode 122 - Dex for Early Post-Intubation Sedation?

    Episode 122 - Dex for Early Post-Intubation Sedation?

    Episode 121: Pearls for Resuscitating the VAD Patient

    Episode 121: Pearls for Resuscitating the VAD Patient

    Episode 121: Pearls for Resuscitating the VAD Patient

    Episode 120: Does Lactated Ringer's Increase Serum Lactate Levels?

    Episode 120: Does Lactated Ringer's Increase Serum Lactate Levels?

    Episode 120: Does Lactated Ringer's Increase Serum Lactate Levels?

    Episode 119: Is a Restrictive Fluid Strategy Better for Septic Patients?

    Episode 119: Is a Restrictive Fluid Strategy Better for Septic Patients?

    Episode 119: Is a Restrictive Fluid Strategy Better for Septic Patients?

    Article: Corl KA, et al. The restrictive IV fluid trial in severe sepsis and septic shock (RIFTS): A randomized pilot study. Crit Care Med. 2019; epub ahead of print.
    Background
    Research indicates that administering IVF to increase stroke volume and organ perfusion concurrently damages vascular integrity leading to organ edema and dysfunction
    Observational studies have associated high volume IVF resuscitation with increased mortality
    Optimum IVF resuscitation strategy in sepsis uncertain
    Study Objective
    Assess the feasibility and initial efficacy of a restrictive resuscitation strategy that significantly limits the amount of IVF administered to septic patients over the first 72 hours of ED and ICU care
    Study
    Randomized trial conducted in EDs and ICUs of 2 US hospitals (Brown and B&W)
    Patients
    Included
    Adult patients > 18 years of age
    Admitted from the ED to the ICU
    Suspected by the treating physician of having severe sepsis or septic shock by Sepsis 2.0
    Allowed patients with = 4 mmol/L after 1 L of IVF
    Interventions
    First 72 hours of treatment
    Restrictive IVF Group
    Permitted to receive up to 60 ml/kg
    Usual Care Group
    Received resuscitative IVF without any pre-specified or suggested limits
    Resuscitative Fluids included all IVF boluses (NS and LR) and maintenance IVF
    Target MAP was 65 mm Hg with IVFs and vasopressors
    Type and timing of vasopressors not restricted
    IVFs with meds termed non-resuscitative IVFs and not restricted. Albumin, TPN, and blood products also considered non-resuscitative IVFs
    Primary outcome: 30-day all-cause mortality
    Results
    109 formed final study cohort; 55 in restrictive group and 54 in usual care group
    IVF Resuscitation
    Restrictive group: 47.1 ml/kg
    Usual care group: 61.1 ml/kg
    Difference of 14.0 ml/kg; 823 m
    Primary outcome
    Restrictive group: 21.8%
    Usual care group: 22.2%
    Adjusting for baseline imbalances in CKD and amount of nonresuscitative IVFs yielded no difference in observed 30-day mortality
    Secondary outcomes
    No difference in 60-day mortality, ICU or hospital LOS, rates of new organ failure, or changes in electrolytes
    Did not observe a significant difference between groups in the number of ventilator free days among the 32 participants with respiratory failure, the restrictive group spent 22 fewer hours ventilated that usual group
    Limitations
    Sample sizes of pilot trials makes it underpowered to detect superiority or noninferiority in mortality
    Patients and providers not blinded to the intervention
    Relatively small difference in IVF between study arms may not reach clinical significance (823 ml)
    Did not incorporate a formalized measurement of volume status or fluid responsiveness
    Selection bias by excluding those who received more than 60 ml/kg - less sick study cohort
    Take Home Point
    A restrictive fluid strategy in patients with severe sepsis or septic shock did not appear to increase mortality, organ dysfunction, or adverse events

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