Fluid in septic LRTI

[LondonMedic]

For instance, there's an abstract in JEMS that describes the use of a portable lactate analyzer to guide fluid therapy by EMS. (See abstract #1), with some suggestive, positive, results.

The study you link to didn't use lactate levels to guide fluid therapy ("Treatment was not dictated by this study and was administered according to EMS protocols."). It is a technically poor study that shows that IV fluid lowers serum lactate - something that won't come as a shock to most of us.

 

[Veneficus]

The study you link to didn't use lactate levels to guide fluid therapy ("Treatment was not dictated by this study and was administered according to EMS protocols."). It is a technically poor study that shows that IV fluid lowers serum lactate - something that won't come as a shock to most of us.

Along the same lines, I atended a seminar on the use of bicarb to theraputically lower lactate in the ICU.

The speaker made a really good case that it is pointless to do this because all it does is mask pathology, it doesn't really treat it.

Another point was since lctate is a by product coming out of permiable cells, while it alters lactate levels in the blood, it doesn't actually restore aerobic metabolism in cells that can do it.

 

[KellyBracket]

The study you link to didn't use lactate levels to guide fluid therapy ("Treatment was not dictated by this study and was administered according to EMS protocols."). It is a technically poor study that shows that IV fluid lowers serum lactate - something that won't come as a shock to most of us.

Shock - I get it.

Yeah, "guide" was a poor choice of words, and a small abstract only published on the JEMS website isn't the highest quality evidence to wave around. Regardless, it's an example of EMS using lactate levels in the field, associated with some benefit, despite the lack of a protocol.

In the same vein, though, the two studies I reviewed at Prehospital sepsis - new research both show that EMS, even without specific training or protocols, is able to identify and improve processes of care for septic patients. Imagine how much better care could be if we devoted some education and training to it.

 

[Melclin]

Anybody else like to offer some wisdom on formulas to guide fluid in these pts?

Shock - I get it.

Yeah, "guide" was a poor choice of words, and a small abstract only published on the JEMS website isn't the highest quality evidence to wave around. Regardless, it's an example of EMS using lactate levels in the field, associated with some benefit, despite the lack of a protocol.

In the same vein, though, the two studies I reviewed at Prehospital sepsis - new research both show that EMS, even without specific training or protocols, is able to identify and improve processes of care for septic patients. Imagine how much better care could be if we devoted some education and training to it.

Mate you're killing me with these lit review/blog post/common language summaries.. I've been working on something similar for a few months but I'm too stupid to come up with anything I'd want in the public eye...then you come along and do something similar but much better. Nice work..you prick. Keep it up

 

[Doczilla]

Along the same lines, I atended a seminar on the use of bicarb to theraputically lower lactate in the ICU.

The speaker made a really good case that it is pointless to do this because all it does is mask pathology, it doesn't really treat it.

Another point was since lctate is a by product coming out of permiable cells, while it alters lactate levels in the blood, it doesn't actually restore aerobic metabolism in cells that can do it.

Yup. Bicarb might make you feel better if you want to just look at the numbers.