Podcasts about plasmalyte

The Filtrate:Joel TopfNayan AuroraSophia AmbrusoWith Special Guest:Michael CollinsEditor:Nayan AuroraShow Notes:Twitter is now X (NYT)Michael Collins (the astronaut, not the real one)PlasmaLyte by BaxterNephJC BEST Fluids summaryEarly Goal Directed Therapy for Sepsis NEJM manuscript which changed practice patterns and welcomed in an era of massive fluid resuscitation.PLUS Trial NEJMSPLIT Trial JAMABaSICS NephJC SummarySALTED and SMART NephJC SummaryAdaptive minimization wikipediaBEST Fluids statistical planBEST Fluids in CLinicalTrials.govDelayed Graft Function review in American Journal of TransplantBalanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis in NEJM EvidenceA pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO) in Kidney InternationalTubular SecretionNayan finally getting around to Succession on HBOSophia autoimmune protocol dietHawthorne EffectMichael Stephen Fry reading Harry Potter

Pediatrik diyabetik ketoasidoz (DKA) patogenez ve temel klinik özellikleri ile erişkin DKA'ya benzese de yönetiminde bazı farklılıklar içeriyor. Üstelik bu farklılıklar kritik öneme sahip. Hem International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022​1​ hem de British Society for Paediatric Endocrinology and Diabetes (BSPED) 2021​2​ kılavuzlarında çocuklarda DKA yönetiminin deneyimli merkezlerde gerçekleştirilmesi, bölgesel koşullara göre telefon veya video konferans görüşmesi aracılığıyla pediatrik DKA için deneyimli bir uygulayıcı ile beraber değerlendirilmesi öneriliyor. Ancak mecburi hizmet koşullarında işler her zaman planlandığı gibi gitmeyebiliyor. Bu yazı da böyle anlardaki ihtiyaca yönelik, ISPAD ve BSPED kılavuzlarının pratik bir özetini sunmayı amaçlıyor. Ayrıca BSPED kılavuzunda linki verilen DKA hesap aracına da buradan ulaşabilirsiniz. 1. ISPAD KILAVUZU DKA TANI KRİTERLERİ Hiperglisemi: >200mg/dl (>11mmol/L) Venöz pH

En este nuevo episodio intento analizar una pregunta clásica, ¿Qué es mejor los sueros balanceados o el suero salino para el paciente crítico? Para ello, me basaré en el articulo publicado en marzo de 2022 en la New England Journal of Medicine “Solución multielectrolito equilibrada frente a salina en adultos gravemente enfermos” La bibliografía utilizada para el episodio: Finfer, S., Micallef, S., Hammond, N., Navarra, L., Bellomo, R., Billot, L., Delaney, A., Gallagher, M., Gattas, D., Li, Q., Mackle, D., Mysore, J., Saxena, M., Taylor, C., Young, P., Myburgh, J., PLUS Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group, & PLUS Study Investigators and Australian New Zealand Intensive Care Society Clinical Trials Group (2022). Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. The New England journal of medicine, 386(9), 815–826. https://doi.org/10.1056/NEJMoa2114464 Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA 2021;326:818-829. Hammond NE, Zampieri FG, Di Tanna GL, et al. Balanced crystalloids versus saline in critically ill adults — a systematic review with meta-analysis. NEJM Evid 2022;1(2). DOI: 10.1056/EVIDoa2100010. Ramanan M, Attokaran A, Murray L, et al. Sodium chloride or Plasmalyte-148 evaluation in severe diabetic ketoacidosis (SCOPE-DKA): a cluster, crossover, randomized, controlled trial. Intensive Care Med 2021;47:1248-1257. Self WH, Evans CS, Jenkins CA, et al. Clinical effects of balanced crystalloids vs saline in adults with diabetic ketoacidosis: a subgroup analysis of cluster randomized clinical trials. JAMA Netw Open 2020;3(11):e2024596-e2024596.

In this episode, we discuss a recently published PLUS study comparing saline solution with Plasmalyte-148. This study demonstrated no significant mortality difference between the saline group and the plasmalyte-148 group.

BaSICS trial leads Drs Fernando Zampieri & Alexandre Biasi Cavalcante join Rob Mac Sweeney to address some of the questions and comments that arose following the presentation and publication of the BaSICS trial results.

One of the fundamentals of therapy for severe Diabetic Ketoacidosis (DKA) is fluids.  However, it is well known that aggressive fluid replacement with Normal Saline commonly results in a non-anion gap metabolic acidosis as the underlying condition improves. Does this acidosis cause harm?  Can it be avoided? In this edition of the podcast, Todd chats to intensivist Dr Mahesh Ramanan about his recently completed study, SCOPE, which compared the effects of buffered solution Plasmalyte 148 with normal saline in these patients. This is another great podcast interview from the 2021ANZICS Clinical Trials Group meeting in Noosa See omnystudio.com/listener for privacy information.

Intravenous fluid therapy is one of the most common interventions in acutely ill patients. Each day, over 20% of patients in intensive care units (ICUs) receive intravenous fluid resuscitation and more than 30% receive fluid resuscitation during their first day in the ICU. Virtually all hospitalized patients receive intravenous fluid to maintain hydration and as diluents for drug administration. Until recently, the amount and type of fluids administered was based on a theory described over 100 years ago, much of which is inconsistent with current physiological data and emerging knowledge. Despite their widespread use, various fluids for intravenous administration entered clinical practice without a robust evaluation of their safety and efficacy. High-quality, investigator-initiated studies have revealed that some of these fluids, notably hydroxyethyl starch and other synthetic colloids, have unacceptable toxicity; as a result, several have been withdrawn from the market whereas others, controversially, are still in use. The belief that dehydration and hypovolaemia can cause or worsen kidney and other vital organ injury has resulted in liberal approaches to fluid therapy and the view that fluid overload and tissue oedema are ‘normal’ during critical illness; this is quite possibly harming patients. Increasing evidence indicates that restrictive fluid strategies might improve outcomes. For generic use, a buffered salt solution such as Plasmalyte or Hartmanns (Lactated Ringers) is a safe first choice. In patients with septic shock not responding to crystalloid resuscitation, albumin is a rationale second choice. Although the evidence is less clear, normal saline should be the first choice for a patient with acute brain injuries; albumin in a hypotonic carrier fluid is contra-indicated for such patients. There is no role for hydroxyethyl starch solutions is acutely or critically ill patients and their continued use harms patients.

Intravenous fluid therapy is one of the most common interventions in acutely ill patients. Each day, over 20% of patients in intensive care units (ICUs) receive intravenous fluid resuscitation and more than 30% receive fluid resuscitation during their first day in the ICU. Virtually all hospitalized patients receive intravenous fluid to maintain hydration and as diluents for drug administration. Until recently, the amount and type of fluids administered was based on a theory described over 100 years ago, much of which is inconsistent with current physiological data and emerging knowledge. Despite their widespread use, various fluids for intravenous administration entered clinical practice without a robust evaluation of their safety and efficacy. High-quality, investigator-initiated studies have revealed that some of these fluids, notably hydroxyethyl starch and other synthetic colloids, have unacceptable toxicity; as a result, several have been withdrawn from the market whereas others, controversially, are still in use. The belief that dehydration and hypovolaemia can cause or worsen kidney and other vital organ injury has resulted in liberal approaches to fluid therapy and the view that fluid overload and tissue oedema are ‘normal’ during critical illness; this is quite possibly harming patients. Increasing evidence indicates that restrictive fluid strategies might improve outcomes. For generic use, a buffered salt solution such as Plasmalyte or Hartmanns (Lactated Ringers) is a safe first choice. In patients with septic shock not responding to crystalloid resuscitation, albumin is a rationale second choice. Although the evidence is less clear, normal saline should be the first choice for a patient with acute brain injuries; albumin in a hypotonic carrier fluid is contra-indicated for such patients. There is no role for hydroxyethyl starch solutions is acutely or critically ill patients and their continued use harms patients.  

Sepsis Awareness Month continues! Join the EMGuideWire Team as they dive into the issues of Fluid selection for resuscitation.  1) Fluids are not all created equal. Use balanced fluids for large volume resuscitation. 2) Lactated Ringers is likely the best choice available in the ED. Plasmalyte is also a good option, if you have it. 3) You can start low dose vasopressors peripherally if you need to, rather than continuing to flood patients with fluids for hypotension.

Dr. Tom Lewis MD and Dr. Chuck Sheppard MD discuss the differences of IV fluids and fluid concentrations. They also discuss case examples and reasons to use specific fluids in certain patients for better outcomes. The variety of fluids including Lactated Ringers, normal saline and now the more reasonable cost of plasmalyte and normasol makes choosing the right fluid for pre-hospital care more complex. Our hope is to clear up some of the confusion.

The second of my series of podcast interviews with keynote speakers from the 2016 ANZICS CTG meeting in Noosa is with Professor John Myburgh. John needs little introduction to anyone in the critical care field, with a PhD in catecholamine physiology and a co-author / principle investigator on a number of practice changing papers including the CHEST and SAFE fluid trials. John joins me to chat about his latest ground-breaking project, the PLUS trial (PlasmaLyte 148 versUs Saline) in ICU patients.

Fluids in Critical Care: Time to SPLIT With Normal Saline? Summary by: Paul Young Intravenous fluid therapy is a ubiquitous treatment for critically ill patients and has been used in clinical practice for over 175 years. Despite this long history, the majority of intravenous fluids have not been subjected to the same level of scrutiny as other drugs. That said, large-scale fluid trials evaluating albumin and starch solutions compared to 0.9% saline have been conducted and their results have changed clinical practice around the world so that crystalloid fluid therapy is now predominant in many parts of the world. While 0.9% saline is the world’s most commonly prescribed crystalloid fluid, increasingly clinicians are turning to buffered or balanced crystalloid solutions as an alternative to 0.9% saline. This practice change from 0.9% saline towards balanced crystalloids is not based on high quality evidence but is supported by observational data suggesting that saline may be associated with an increased risk of renal toxicity and mortality compared to buffered crystalloids. This talk gives an overview of the data comparing the comparative effectiveness of 0.9% saline and buffered crystalloids, provides an overview of the historical context of intravenous fluid therapy (and proctoclysis), and describes the design of the Saline vs. Plasma-Lyte 148® for Intravenous fluid Therapy (SPLIT) trial which has now been completed and was recently published in the Journal of the American Medical Association. External Links• [The Bottom line] SPLIT trial reviewed• [article] Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit The SPLIT Randomized Clinical Trial• [editorial] Editorial accompanying paper• [videocast] Presentation of SPLIT trial at ESICM by Dr Paul Young• [Further reading] Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults• [St Emlyn's] SPLIT trial published. Saline or Plasmalyte on the ICU?

Paul Young is the man of the moment. In one week has has published the SPLIT trial in JAMA, the HEAT trail in the NEJM and presented both at the ESICM conference. Platform Trials. In this interview Paul discusses The SPLIT Trial - the first trial to substantially look at buffered crystalloids vrs saline and now really paves the way for a definitive trial in this area. He answers some questions that have been asked such as was the volume of fluid sufficient to demonstrate an effect, why PlasmaLyte was used and what he’ll be doing following these results. HEAT is a much anticipated trial looking at the effect of early administration of acetaminophen to treat fever due to probable infection. This intervention did not affect the number of ICU-free days. Paul captured out imagination on this topic with a talk at SMACC in 2013 and now the dialogue really begins. We discuss where to go from here on this topic that often stimulates passionate debate… Finally we discuss Platform trials and how they will save the world. This was  topic of a talk Paul gave in Chicago which will be released soon. Read this fascinating paper by Berry Connor and Lewis for a real insight into the hot topic.

In this episode of The FlightBridgeED Podcast, Eric takes a suggestion from our community and dives into the "other" fluids. While these fluids aren't our normal go to solutions, they all have a place in the great field of "Fluidology." Join us as we explore plasmalyte, normosol, and dextran.

In this episode of The FlightBridgeED Podcast, Eric takes a suggestion from our community and dives into the "other" fluids. While these fluids aren't our normal go to solutions, they all have a place in the great field of "Fluidology." Join us as we explore plasmalyte, normosol, and dextran.See omnystudio.com/listener for privacy information.

John Myburgh takes us through 200 years of fluids therapy in critical care in one powerful presentation. He discusses the essential moments from history that changed the way we practice today and puts this long an bizarre story into context. He covers the key aspects of relevant physiology and, inspired by Kipling, the what, where, when, how, why and whom of this intervention that has become synonymous with critical care. He tackles starch controversies with his unique perspective on the subject, as well as the very topical chloride debate and the upcoming SPLIT trial. Best watched with John's superb slide deck. WARNING: this may leave you questioning something you prescribe every day and feeling disturbed that something you assumed to be simple and sorted is far from it. Other talks from John Myburgh include: Beta Blocker and Sepsis Fluid Resuscitation 2013 Decompressive Craniectomy   Catecholamines, resuscitation & resurrection

Cats with urethral obstruction ("blocked cats") can present in a state of shock with moderate-to-severe hypoperfusion and should receive adequate fluid resuscitation with bolus therapy as needed using an isotonic crystalloid solution before worrying about relieving the obstruction. Blocked cats may have clinically significant hyperkalaemia and can also be severely acidaemic. With this in mind, does it matter whether we use 0.9% sodium chloride or a more balanced solution such as Hartmann's solution (buffered lactated Ringer's solution, compound sodium lactate), Normosol-R or Plasmalyte 148? This is discussed in detail in this podcast and a paper from the veterinary literature presented. A summary of the podcast including the reference for the paper discussed can be found on the Veterinary ECC Small Talk website HERE. If you are interested in taking a presentation and acquiring some course notes describing in detail an approach to the overall management of blocked cats, please visit the website HERE.