Hi all–Sorry for the delayed posting, but I just moved to a new apt.
In this episode I rant and rave about why for the most part Emergency Medicine has disappointed me by not doing something about our sick septic patients.
If you are offering aggressive therapy in the ED, then good on you.
Of course everything in this talk stems from River's seminal work: EGDT Study
…but there is more. Don't forget to check out a brief aside (PodCast 14.5), in which I respond to Chris Nickson‘s experience of EGDT in Australia and tell you a bit about the EMCrit Podcast EBM philosophy
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Scott Weingart
An ED Intensivist from NY. No conflicts of interest (coi).
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one of my favorite songs : Dinah Washington: What Difference A Day Makes.
in this case , what a difference 7.5 years makes. we are reconsidering EGDT, fluids, CVP monitoring, even the significance of lactic acid, i think (though a high LA is still not a good thing.). some of us are considering IV Vit C and IV thiamine. after the reanimate 3 course, i like to go to the femoral sites.
Hello to Chris Nickson, who lectured at Reanimate this past march
….. but i think we have come a ways, now in 2017, and still have a ways to go.
still a fine podcast Scott. thank you
tom
Hey Scott,
Great to hear your views and approach to EGDT. I agree with the need for aggressive resuscitation of the septic patient – with fluid, antibiotics, vasopressors (we’re a ‘norad/ norepi shop’ too) and adequate oxygen delivery being the mainstays – and, if nothing else, the Rivers paper deserves credit for bringing this into the spotlight.
However, the Rivers study itself is still a cause of concern for me – a single center study that has never been repeated as an RCT, with a very high mortality in the control arm (mid-40s%), and more recently the WSJ allegations about about methodological ‘dodginess’ behind the scenes and concerns about conflicting financial interests (of which I’m not sure what to make).
Most ICUs in Australia don’t use CV02 monitoring, yet our mortality rates are substantially better than the Rivers study (ICU sepsis mortality around 20% these days, down from 34% in 1997) – different populations or something else? I’m also uneasy about the blood transfusion phase of the Rivers protocol. Hopefully trials like ARISE and ProCESS will help clear up what actually works. In the mean time, I heed your call to resuscitate!
Cheers,
Chris Nickson
ED/ICU Registrar, Perth