Welcome to #TenTweetNephJC
At journal club this week, a question that impacts all intensivists - when patients with septic shock need ongoing resuscitation after their initial 30cc/kg treatment, what strategy for intravenous fluid volume should we use?
Find out in thread👇
At journal club this week, a question that impacts all intensivists - when patients with septic shock need ongoing resuscitation after their initial 30cc/kg treatment, what strategy for intravenous fluid volume should we use?
Find out in thread👇
2/10
What did I miss?
CLASSIC.
They’d piloted it in 2016 with n=151. With 1.4L difference in iv fluid given over an ICU stay there were hopeful signals of less AKI & ischaemia in arm that got less fluid.
This led to the largest RCT on the topic….
pubmed.ncbi.nlm.nih.gov
What did I miss?
CLASSIC.
They’d piloted it in 2016 with n=151. With 1.4L difference in iv fluid given over an ICU stay there were hopeful signals of less AKI & ischaemia in arm that got less fluid.
This led to the largest RCT on the topic….
pubmed.ncbi.nlm.nih.gov
3/10
1 tweet methods
✅ Adults, septic shock on pressors, >1L of resus fluid already
✅ Restricted fluid arm got iv boluses if strict criteria for hypoperfusion met (eg lactate >4, MAP <50 etc)
✅ Standard arm if improvement in haemodynamics as per Surviving Sepsis guidelines
1 tweet methods
✅ Adults, septic shock on pressors, >1L of resus fluid already
✅ Restricted fluid arm got iv boluses if strict criteria for hypoperfusion met (eg lactate >4, MAP <50 etc)
✅ Standard arm if improvement in haemodynamics as per Surviving Sepsis guidelines
4/10
1 tweet results
🔹n=1554, in Europe
🔹Randomised 1:1 at median 3 hours into ICU stay, after median of 3L iv fluid already
🔹 By day 5 restrictive group had further median 1450ml in, standard 3077ml in
🔹 Primary outcome of 90 day mortality = 42.3% versus 42.1% (p=0.84)
1 tweet results
🔹n=1554, in Europe
🔹Randomised 1:1 at median 3 hours into ICU stay, after median of 3L iv fluid already
🔹 By day 5 restrictive group had further median 1450ml in, standard 3077ml in
🔹 Primary outcome of 90 day mortality = 42.3% versus 42.1% (p=0.84)
5/10
A figure paints 1000 words
A figure paints 1000 words
7/10
Chat consensus?
1⃣ Fluid prescription in this well done RCT was much less than we anecdotally see given at times…
2⃣ Great now have point of care ultrasound practitioners for the win
3⃣ The pre-specified analysis of respiratory support sub-group does look intriguing👇
Chat consensus?
1⃣ Fluid prescription in this well done RCT was much less than we anecdotally see given at times…
2⃣ Great now have point of care ultrasound practitioners for the win
3⃣ The pre-specified analysis of respiratory support sub-group does look intriguing👇
9/10
I want more info
✅ Find more detail in the great summary from @vishnurenal and @nephrokavitha
nephjc.com
✅ Check out fantastic visual abstract👇 by @SayaliBThakare
I want more info
✅ Find more detail in the great summary from @vishnurenal and @nephrokavitha
nephjc.com
✅ Check out fantastic visual abstract👇 by @SayaliBThakare
10/10
Final thoughts
✳️ RCT showed safety of protocolised iv fluid restriction, but with cumulative fluid balance separated by <1L it was destined to be negative
➡️ Almost book club time! Join us on 23/24 August, still time to read The Code Breaker!
Tweetorial by jamiekwillows
Final thoughts
✳️ RCT showed safety of protocolised iv fluid restriction, but with cumulative fluid balance separated by <1L it was destined to be negative
➡️ Almost book club time! Join us on 23/24 August, still time to read The Code Breaker!
Tweetorial by jamiekwillows
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