Critical Care Time 58. Cases in Congestion with Dr Ross Prager
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Sep 15, 2025 Dr. Ross Prager, a seasoned physician, joins Cyrus and Nick to dissect the intricacies of volume assessment in critical care. They explore fascinating real-life cases that emphasize the careful monitoring of fluid management. The discussion critiques traditional IV fluid administration based on low blood pressure, highlighting the importance of microcirculation assessment. Dr. Prager and the hosts examine the delicate balance of fluid therapy in ICU settings, particularly in COVID patients, stressing individualized strategies for optimal patient outcomes.
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Start With The Microcirculation
- Ross Prager prioritizes microcirculation assessment before fluids, vasopressors, or inotropes.
- End-organ perfusion markers (cap refill, lactate, urine) guide whether any hemodynamic action is needed.
Check Fluid Tolerance First
- Assess whether a patient is fluid tolerant before testing fluid responsiveness.
- Consider acute illness, comorbidities, and congestion to estimate harm from IV fluids.
Vasopressors Can Replace Some Fluids
- Vasopressors can recruit unstressed venous volume and increase venous return without giving fluids.
- Low filling pressures don't always mean fluids are the best fix for low stroke volume.