November 2015: Balanced Fluid Resuscitation in Sepsis
This month JC looks at the topic of 'balanced fluid resuscitation’ in sepsis. There was a recent article recalled seeing in EP Monthly as well as a brief ACEP point-counter-point and the excellent resident blog Everyday E(B)M at Wash U. A Pub-Med search led me to our included articles and a link to a recent meta-analysis not included. Two articles are retrospective so I have included an EBM read on how to properly assess articles based upon chart reviews. Finally, a brief essay in JAMA from John Ioannidis a true pioneer. Dr. Ioannidis in 2005, shook the medical community with what is still the most cited and downloaded article in the history of PLOS. If you don’t know his work, The Atlantic did a great article a few years ago that is worth the read. He gives us a lot to think about. Should make for an interesting JC. As always, free to tweet your perspective
P: In patients with evidence of sepsis requiring fluid resuscitation
I: Does the use of balanced fluid resuscitation
C: Compared to 0.9% normal saline alone
O: Improve patient centered outcomes (morbidity, mortality)
PGY-2's: Young P et al. Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial. JAMA. 2015 Oct 27;314(16):1701-10
All: Yunos NM et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012 Oct 17;308(15):1566-72.