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Sepsis and Fluid Resuscitation
2 Minute EBP Challenge
Stay up-to-date the easy way!
How would you answer this question?
Intravenous fluids are used in the resuscitation of severe sepsis. What statement is correct regarding the administration of fluids in severe sepsis?
a. Crystalloids are more effective in restoring blood pressure.
b. Colloids decrease the risk of renal dysfunction.
c. Less crystalloid is necessary for volume resuscitation.
d. Hospital mortality was similar regardless of fluid choice.
The correct answer is "d" hospital mortality was similar regardless of fluid choice.
The International Guidelines for Management of Severe Sepsis and Septic Shock issued by the Society of Critical Care Medicine (SCCM) recommend using crystalloids in the initial resuscitation of severe sepsis. Other authors suggest the utility of using colloids in resuscitation.
Drs. Bayer and colleagues (2012) sought to settle the dispute in their recent study where they found similar time to resuscitation and hospital mortality regardless of fluid choice. Colloids were associated with an increased risk of renal dysfunction though.
If crystalloids and colloids were equally effective in resuscitation, then why not use both rather than choosing one as a favorite resuscitation tool? Following the SCCMs recommendations, one could start by administer crystalloids and if they were ineffective add colloids to the resuscitation. Of course colloids might be withheld if the patient is at risk for renal dysfunction or is already exhibiting signs of acute kidney disease.
From: Bayer, O., et al. (2012). Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: A prospective sequential analysis. Critical Care Medicine, 40(9), 2543-2551.
Congratulations to Allison Karon who won a copy of my What You Don't Know About Vital Signs DVD for answering this week's question correctly. Congratulations Allison!
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David W. Woodruff, MSN, RN-BC, CNS, CMSRN, CEN
President, Ed4Nurses, Inc.
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