Resuscitation-Cooling-Drugs and fluids/CCM Board review

8/10/2019 Resuscitation-Cooling-Drugs and fluids/CCM Board review

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Rivers et al NEJM 2001.

Early Goal DirectedTherapy

263 patients randomized to

6 hrs of usual care or EGDT ! in-hospital mortality withEGDT (30.5% vs 46.5%)

The approach to

resuscitation matters!

EGDT pts received 1.5 litersmore fluid than control pts inthe first 6 hours


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Potential harm

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Gut edema

Abdominalcompartment

syndrome

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Cerebral edema

RV overload

Electrolyte abnl


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Feissel et al. Intensive Care Med 2004.

" s in IVC diameter with

mech insufflation predictfluid responsiveness in ptsreceiving MV

E/'3(#*$+4

Max DIVC - Min DIVC x 100

Min D IVC

Max DIVC - Min DIVC x 100 Avg DIVC

>18% predicts response

>12% predicts response

Caveats: obesity, " IAP

Barbier et al. Intensive Care Med 2004.


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Resuscitation-Cooling-Drugs and fluids/CCM Board review