Prepared for a brief talk at our joint ICU ED meeting. References at emergencymedicineireland.com

1. sepsis

2. where’s the controversy
fluids goals

3. fluids

4. give more give less
fluids

5. “give exactly the amount of fluid that they need
and not a drop more”

6. “It is time to go back to basics and
challenge our entrenched
assumption that fluid resuscitation
is beneficial for people in septic
shock, rather than continue to
argue over which fluid works
best.”

7. goals
CVP
cardiac output
BP
lactate
[jones 2010]
ScvO2
[rivers 2001]

9. ARISE PROMISE PROCESS

10. the details
•multi centre
•RCT
•blinded assessors but not patients or
docs
•early in the sepsis course
•had to get a decent bolus of fluids before
they could get in
•powered with an assumption of 35-40%
mortality

11. the interventions
EGDT
protocol
protocol based
on expert
consensus
usual care

12. the results
•31 centers screening 12000 pts and got
1300
•no difference in primary outcome
•difference in fluids ‘significant’ but in
reality <1000ml
•other differences are protocol related

13. rivers 2001
process 2014
kaukonen 2014

14. the bottom line
•we seem to be getting better at this
•fluids, antibiotics, source control...
•paying attention matters
•“keep it simple stupid”