Resuscitation Conference Podcast

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

Episode 123: An Update on Fluids in Neurocritically Ill Patients

Episode 122 - Dex for Early Post-Intubation Sedation?

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 < 2 SIRS criteria to be enrolled if the treating attending believed sepsis to be their primary cause of illness Have refractory hypotension (MAP < 65 mm Hg) or lactate >= 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

Episode 118 - Ventilating the Crashing Obese Patient

Pearls for Patients with Acute UGIB

Should Post-Arrest Patients without STEMI Receive Immediate Angiography?

Episode 113 - Is Capillary Refill Time A Better Marker of Perfusion Than Lactate? The ANDROMEDA-SHOCK Trial

Episode 112: Does This Patient Have Tamponade?

Episode 111: Is This Patient Going to Be a Difficult Intubation?

Episode 110: Push Dose Pressors in the Crashing Patient

Episode 109: Routine Care Does Cause Pain in Your Critically Ill Patient

Episode 108: Ultrasound for ETT Confirmation

Episode 107: Is Low-Tidal Volume Ventilation Beneficial in Patients Without ARDS?

Episode 106: What is Your MAP Goal for the Post-Arrest Patient?

Episode 94: Balanced Crystalloids or Saline for Critically Ill Patients?

Is Hyperoxia Bad for Your Post-Arrest Patient?

Episode 90 - What's New in Hemorrhagic Shock?

Episode 88: Predictors of Intubation with NIV - Know These Numbers!

Episode 86: ETCO2 for Cardiac Arrest - Do You Know the Right Values?

Episode 85: POCUS

Episode 84: What's the best CO2 tension post-arrest?

Episode 83: Flush rate preoxygenation before intubation

Episode 82: More support for shock index

Episode 81: NEWS vs. QSOFA

Episode 80: Post-intubation sedation vs. analgesia?

Episode 79: More on hyperoxia...

Episode 78: Is your patient fluid-responsive?

Episode 77: RSI drugs in obesity

Episode 76: CXR vs US for CVC placement

Episode 75: How should you intubate during cardiac arrest??