It’s time to question what we’re doing

Administration of intravenous fluid is one of the key therapies in the ICU for treating one of our most common and lethal diseases—sepsis. There’s been a large reduction in sepsis mortality, which is partially attributable to early and aggressive fluid administration. However, several recent investigations have raised questions about the appropriateness of current fluid practice.

These questions will be addressed during the Monday session Six Controversies in Fluid Administration in Sepsis. The session covers the latest research and the edge of evidence for sepsis fluid administration.

“These are questions every intensivist grapples with,” says session chair Michael J. Lanspa, MD, ATSF, of Intermountain Medical Center in Salt Lake City, Utah. “Many of them don’t have a simple answer.”

The questions that will be covered by session panelists include:

What target are we striving for when we administer fluid? How do we know the fluid challenge worked? Traditionally, we would assess increases in stroke volume, or delivery of oxygen. However, perhaps an increase in blood pressure or the improvement of lactate might be better goals.

How do we predict response to fluid? Some novel technologies are supposedly better at predicting fluid, but they have limitations as well.

When should we administer fluid? There may be big differences in early versus later administration, and strategies that work well early on may not fare as well six hours later.

What type of fluid should be administered? There is growing evidence about the harms of saline. Different populations may respond differently to certain types of fluid.

What harms are associated with excess fluid administration? Many studies suggest harm, but is this real or simply confounding by indication?

When it is appropriate to diurese or dialyze patients in sepsis? This is a common question asked by perhaps every intensivist and is one of the most exciting.

“Although fluid therapy is over a century old, there is still a lot of uncertainty on how best to administer fluid,” Dr. Lanspa says. “This session is important for ATS attendees because experts in the field will not only discuss the most recent science, but will offer insights for the bedside clinician and the researcher. After this session, we expect that attendees will not only be aware of all the recent scientific developments in this field, but will also walk away with a conceptual framework of how to deal with these controversies.”