Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness. A couple of weeks back the PGY-1 and 2 residents met and discussed a number of questions they had about the care and management of patients with sepsis. The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc. Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients. After searching the literature, they decided to take a closer look at these articles:
- Kanji, H., McCallum, J., Sirounis, D., MacRedmond, R., Moss, R., & Boyd, J. (2014). Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. Journal of Critical Care, 29(5), 700–705. doi:10.1016/j.jcrc.2014.04.008
- Duus N, et al, The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients, J Crit Care (2014), http://dx.doi.org/10.1016/j.jcrc.2014.07.031
- Kupersztych-Hagege, E., Teboul, J., Artigas, A., Sabatier, C., Richard, C., & Monnet, X. (2013) Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. British Journal of Anaesthesia. 11(6). doi:10.1093/bja/aet282
Here are the analysis sheets for each of the papers:
Take a listen to the podcast to hear a breakdown of the papers and some really helpful clinical context from one of our local EM-Intensivists, Adarsh Srivastava.
If you are thirsting for more knowledge and are looking to go down the rabbit-hole that is fluid resuscitation in sepsis, here are some additional FOAM links you should read/listen to:
- EMCrit Podcast #64 Fluid Responsiveness with Paul Marik, MD
- EMCrit Podcast #111 Fluids in Sepsis, A New Paradigm
- EMCrit Podcast #112 A Response to the Marik Sepsis Fluids Lecture
- EMLyceum Fluids Responsiveness "Answers"
- Haney Mallemat - The Art and Science of Fluid Responsiveness
- Fluid Responsiveness - LITFL
Thanks to Josh Denney, MD, Andrew Latimer, MD, and Kyle Nizolek, MD, PGY-3 residents in the University of Cincinnati Dept of EM Residency Training Program for their leadership of the journal club discussion and to the residents and faculty for their vibrant discussion of the topic!