SCCM Resource Library-Assessing End Points of Resuscitation in the ICU

Video Transcription

Video Summary

Dr. Greg Martin discusses the importance of fluid resuscitation in dehydrated patients in the ICU but highlights the need for better understanding of which patients will benefit and how to select the right fluid. He addresses the clinical concerns around fluid therapy and the adverse consequences of fluid overload. Dr. Martin emphasizes the use of individualized fluid therapy and precision resuscitation to improve outcomes. <br /><br />Dr. Colin Grissom discusses the use of diuresis after shock resolution in patients with ARDS. He presents evidence from the FACT and FACT-Lite trials showing that a fluid conservative approach, including diuretics, leads to improved outcomes compared to a liberal fluid strategy. Dr. Grissom emphasizes the importance of regular evaluation of urine output and CVP to guide diuresis, and suggests using echocardiography to estimate CVP in patients with low albumin levels. He also discusses the use of the passive leg raise maneuver and change in cardiac index to predict tolerance of negative fluid balance in patients with shock. Dr. Grissom concludes that diuresis, guided by CVP or echocardiography, can reduce complications associated with fluid overload. Lastly, he addresses the use of maintenance fluids, stating that evidence does not support their continued use and that diuresis should be the goal, taking individual patient factors into consideration.

Asset Subtitle

Pharmacology, Resuscitation, 2019

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2019 Critical Care Congress on IV fluids and resuscitation.

Examine the evidence for choice of resuscitation fluids
Recognize that volume overload contributes to increased mortality
Determine fluid responsiveness using invasive and noninvasive methods
Apply ultrasound techniques to evaluate fluid responsiveness

Choice of Fluids for Resuscitation and Avoiding Fluid Overload
Greg S. Martin

Determination of Fluid Responsiveness After Initial Resuscitation: Invasive Methods
Michael R. Pinsky

Determination of Fluid Responsiveness After Initial Resuscitation: Noninvasive Methods
Michael J. Lanspa

Focused Cardiac Ultrasound to Determine Fluid Responsiveness
Jose L. Diaz-Gomez

Fluid Management After Shock Resolves
Colin K. Grissom

Meta Tag

Content Type Presentation

Knowledge Area Pharmacology

Knowledge Area Resuscitation

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Fluids Resuscitation Management

Year 2019

Keywords

fluid resuscitation

dehydration

ICU patients

fluid therapy

fluid overload

individualized fluid therapy

diuresis

shock resolution

ARDS

urine output

CVP

echocardiography

low albumin levels

passive leg raise maneuver

cardiac index

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