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JAMAevidence The Rational Clinical Examination

Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids? Interview with Dr Peter Bentzer

Feb 7, 2019
Dr. Peter Bentzer, an expert in hemodynamic responses in unstable patients, delves into the complexities of fluid management post-resuscitation. He discusses the potential risks associated with aggressive intravenous fluid therapy, highlighting increased mortality rates. Bentzer explains how about 50% of unstable patients may benefit from further fluid administration and explores challenges in assessing fluid responsiveness, particularly in mechanically ventilated cases. He also emphasizes practical bedside techniques like passive leg raising for evaluating fluid needs.
14:13
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Episode guests

Peter Bentzer

Podcast summary created with Snipd AI

Quick takeaways

  • Administering excessive fluids to hemodynamically unstable patients can lead to serious complications, emphasizing the need for careful fluid management.
  • Approximately 50% of unstable patients may respond to fluid administration, but traditional signs of hypovolemia are poor predictors of this response.

Deep dives

Risks of Excessive Fluid Administration

Administering excessive intravenous fluid to patients who remain hypotensive after resuscitation can lead to significant complications such as edema formation and compartment syndromes, which negatively impact organ function. Observational studies indicate a correlation between positive fluid balance and increased mortality, suggesting that careful consideration is necessary when administering fluids. While a study from the RDS Network showed that restrictive fluid therapy could reduce the duration of mechanical ventilation in ARDS patients, the causality between fluid balance and outcomes remains unclear. Therefore, healthcare providers must balance the potential benefits of fluid administration against these adverse effects to improve patient outcomes.

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