{"id":411,"date":"2013-03-17T23:12:41","date_gmt":"2013-03-17T22:12:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc-archimedes\/?p=411"},"modified":"2013-03-18T10:14:03","modified_gmt":"2013-03-18T09:14:03","slug":"worried-about-sepsis-very-worried","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2013\/03\/17\/worried-about-sepsis-very-worried\/","title":{"rendered":"Worried about sepsis. Very worried."},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" alt=\"\" src=\"http:\/\/newnurseblog.com\/wp-content\/uploads\/2011\/12\/397959-351-4.jpg\" width=\"153\" height=\"204\" \/>I have spent my entire professional career giving boluses of fluid to patients with septic shock, from the very first paediatric patient I met on call (&#8220;You&#8217;re the paed? We need you, this lad&#8217;s sick.&#8221;) through imprints of 50ml syringes squeezed into infants to over-the-phone requests to run another 500 ml of saline in while I scrabbled for a clean shirt and car keys.<\/p>\n<p>I didn&#8217;t really use much albumin, or starches, or blood product for the purpose. (Which was probably good for quite a few reasons &#8230; <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD001208.pub4\/abstract\">A<\/a> <a href=\"http:\/\/www.crd.york.ac.uk\/crdweb\/hydroxyethyl.asp\">B<\/a> <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD000567.pub6\/abstract\">C<\/a>.) But I did, and probably will next week, do fluid\u00a0resuscitation.<\/p>\n<p>Which is why the <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1101549\">FEAST trial<\/a> of the treatment of septic shock in African children unnerved me a little, but a <a href=\"http:\/\/adc.bmj.com\/content\/96\/10\/905.full\">reassuring\u00a0analysis of the differences <\/a>settled me down. \u00a0Now a specific <a href=\"http:\/\/www.biomedcentral.com\/1741-7015\/11\/68\">reanalysis of the data in BioMedCentral<\/a> has asked those questions of the trial; was it that the deaths were in the severely anaemic, or those with respiratory illnesses (in the setting of no ventilators) leading to the excess death. No. It seems not.<\/p>\n<p>Indeed the group with with worse volume depletion (high lactates etc) seemed to fare worse. Is this a reperfusion injury issue? Is this, like <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD007160.pub2\/abstract\">oxygen for acute MI<\/a>, a case of &#8216;nature knows better&#8217;?<\/p>\n<p>I don&#8217;t know. I cannot bring myself to <strong>not<\/strong> give fluid to the shocked. But I do feel extremely uncertain if I&#8217;m doing more good than harm.<\/p>\n<p>&#8211; Archi<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I have spent my entire professional career giving boluses of fluid to patients with septic shock, from the very first paediatric patient I met on call (&#8220;You&#8217;re the paed? We need you, this lad&#8217;s sick.&#8221;) through imprints of 50ml syringes squeezed into infants to over-the-phone requests to run another 500 ml of saline in while [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2013\/03\/17\/worried-about-sepsis-very-worried\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79],"tags":[],"class_list":["post-411","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Worried about sepsis. Very worried. - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2013\/03\/17\/worried-about-sepsis-very-worried\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Worried about sepsis. Very worried. - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"I have spent my entire professional career giving boluses of fluid to patients with septic shock, from the very first paediatric patient I met on call (&#8220;You&#8217;re the paed? We need you, this lad&#8217;s sick.&#8221;) through imprints of 50ml syringes squeezed into infants to over-the-phone requests to run another 500 ml of saline in while [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/adc\/2013\/03\/17\/worried-about-sepsis-very-worried\/\" \/>\n<meta property=\"og:site_name\" content=\"ADC Online Blog\" \/>\n<meta property=\"article:published_time\" content=\"2013-03-17T22:12:41+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2013-03-18T09:14:03+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/newnurseblog.com\/wp-content\/uploads\/2011\/12\/397959-351-4.jpg\" \/>\n<meta name=\"author\" content=\"Bob Phillips\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bob Phillips\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2013\\\/03\\\/17\\\/worried-about-sepsis-very-worried\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2013\\\/03\\\/17\\\/worried-about-sepsis-very-worried\\\/\"},\"author\":{\"name\":\"Bob Phillips\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/person\\\/9e94029681ecf36e73bbd1eb2be2ef94\"},\"headline\":\"Worried about sepsis. 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