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I have spent my entire professional career giving boluses of fluid to patients with septic shock, from the very first paediatric patient I met on call (“You’re the paed? We need you, this lad’s sick.”) through imprints of 50ml syringes squeezed into infants to over-the-phone requests to run another 500 ml of saline in while I scrabbled for a clean shirt and car keys.<\/p>\n
I didn’t really use much albumin, or starches, or blood product for the purpose. (Which was probably good for quite a few reasons … A<\/a> B<\/a> C<\/a>.) But I did, and probably will next week, do fluid\u00a0resuscitation.<\/p>\n Which is why the FEAST trial<\/a> of the treatment of septic shock in African children unnerved me a little, but a reassuring\u00a0analysis of the differences <\/a>settled me down. \u00a0Now a specific reanalysis of the data in BioMedCentral<\/a> has asked those questions of the trial; was it that the deaths were in the severely anaemic, or those with respiratory illnesses (in the setting of no ventilators) leading to the excess death. No. It seems not.<\/p>\n Indeed the group with with worse volume depletion (high lactates etc) seemed to fare worse. Is this a reperfusion injury issue? Is this, like oxygen for acute MI<\/a>, a case of ‘nature knows better’?<\/p>\n I don’t know. I cannot bring myself to not<\/strong> give fluid to the shocked. But I do feel extremely uncertain if I’m doing more good than harm.<\/p>\n – Archi<\/p>\n","protected":false},"excerpt":{"rendered":" I have spent my entire professional career giving boluses of fluid to patients with septic shock, from the very first paediatric patient I met on call (“You’re the paed? We need you, this lad’s sick.”) through imprints of 50ml syringes squeezed into infants to over-the-phone requests to run another 500 ml of saline in while […]<\/p>\n