Introduction and Welcome to the 6th iFAD Meeting! - Manu Malbrain
Emphasising the importance of remembering that fluids are drugs.
Fluid are a drug, treat them with respect.
Sepsis 3.0 Was it worth the wait? - Mervyn Singer
There was a clear need for Sepsis 3.0 to update the definitions
Prognostication better but big increase in diagnosis of “sepsis”
Sepsis-3 appears to identify patients at risk better in specific patient groups (https://t.co/yyOAw5ezdj) and outside the ICU (https://t.co/s62RjoiDFE)
qSOFA - intended to be rapid risk stratification tool in patients suspected of having infection
BUT - never intended to be screening tool - ie ignore those with 0 or 1 criteria
What about in kids? pSOFA just published (https://t.co/YwldAqUhbu)
Sepsis 3.0 is a risk stratification device, not a screening tool.
Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department
Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection.
And some FOAMED:
Less is more: what is the best frequency of routine investigations? - Ruth Kleinpell
Choosing Wisely campaign
Avoiding Massive Transfusion - Karim Brohi
8 million cases of major haemorrhage with 2.2 million deaths
Many definitions of massive transfusion ---> 10U RBC in 24 hours
Historic term with little benefit in modern practice beyond study endpoint
Stop the bleeding
Keep them alive
Stop the bleeding
Maintain coagulation process
- Early surgery/haemorrahge control
- Permissive hypotension
- Limiting fluids
- Target coagulopathy
60 years on from Shires and Moore’s plea for ‘Moderation’: Culture eats evidence for breakfast - Monty Mythen
Enhanced Recovery in a nutshell:
CHO preload drinks
Clear fluid till 2hr prep
Avoid salt and water excess
Minimal amount of fluid required for homeostasis
Immediate post op food and drink
Fluids down ASAP
Range from 1-23L surgery for colorectal surgery in some institutions
Get your patients moving, eating and drinking as soon as it possible and safe.