Fluid selection is always a controversial topic. I polled twitter recently and was surprised to find an almost even division between a normal saline versus balanced crystalloid as a resuscitative fluid:
what fluid would you use to resuscitate an average patient with no electrolyte abnormalities?
— josh farkas 💊 (@PulmCrit) June 24, 2019
Based on this polling data, 42% of you will hate this chapter. It's a good thing I'm not running for president.
Seriously though, fluid selection remains controversial. This chapter presents an approach which makes sense physiologically and is supported by a substantial amount of animal and human data.
This is a challenging topic because the effect size of the interventions are extremely small, which makes it difficult to prove hard clinical endpoints in an RCT. However, when leveraged over thousands of patients who are treated with fluid, even a tiny effect size will eventually have meaningful clinical consequences.
The IBCC chapter is located here.
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- IBCC chapter:Guide to APRV for COVID-19 - April 8, 2020
- PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0) - April 2, 2020
- PulmCrit wee – Why the SCCM/AARC/ASA/APSF/AACN/CHEST joint statement on split ventilators is wrong. - March 29, 2020