Thread by @CHESTCritCare

Join us now to learn about Sepsis Antibiotics and Fluids!

Moderated by our co-chair @virenkaul

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Up first is Dr. Angel Coz

Decrease in expected mortality with introduction of sepsis protocol.

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Why broad spectrum antibiotics?? This means:

- not the same for every patient
- based on patient history and source
- based on institutional resistances

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If not broad spectrum or early antibiotics, then what??

Do we wait for cultures?? Maybe not...

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Do we want to target unnecessary antibiotics in sepsis, or rather target unnecessary antibiotics in the outpatient setting and in the animal use.

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Antibiotic STEWARDSHIP is key!

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Thank you Dr. Coz for a great rapid fire talk!!

Dr. Jay Patel to counter Dr. Coz on why broad spectrum and early antibiotics may not be routinely administered routinely to all septic patients. 🔥

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Breaking down what we want in antimicrobial therapy:

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The current guidelines recommends, but "empiric broad spectrum therapy" may be a gray zone.

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The strength of the recommendation of guidelines needs to be looked at - not all recommendations are created equal. What is the value of the recommendation??

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There is harm in giving unnecessary antibiotics, so they are not without risk.

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Hot off the press 🔥🔥

more evidence favoring appropriate antibiotics

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How is appropriate defined??

If appropriate then there is benefit.
If inappropriate then there is harm.

Instead of appropriate vs. inappropriate antibiotics, consider the argument appropriate vs. no antibiotics (if they are harmful).

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But does appropriate equal broad spectrum???

Varying definition of "appropriate" in studies.

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Antibiotic resistances vary between locations/countries. Thus, a broad guidelines for all may not be the best.

Consider individualizing antibiotic choice to the likely clinical infection, community and hospitalization factors.

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In summary by Dr. Jay Patel:
What do you think? Broad spectrum and early antibiotics or not? And what does that mean?

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Next topic!
Fluid in sepsis (30cc/kg or not)

Dr. Chhaya Patel discussing why we SHOULD be giving 30cc/kg to all sepsis patients. 💧💧💧💧

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Starting, looking at assessing fluid responsiveness.

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Surviving Sepsis Guidelines

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Does fluid cause harm?

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What about patient with acute kidney injury (AKI) or congestive heart failure (CHF)?

2016 study, CHF w/septic shock, inadequate fluid resuscitation increased mortality
2020 Mayo Clinic study showed improved mortality in CHF who received adequate fluids

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🔥off the @accpchest press

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Conclusions of 30cc/kg fluids in sepsis

CHF - adequate fluid resuscitation is key if hypotensive
ALI - deresuscitative key post fluid administration
RRT - ? incidence did not seem to be higher when receiving adequate fluid

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Dr. Ivor Douglas up to discuss why NOT giving 30cc/kg fluids in all patients with sepsis is appropriate.

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He argues that therapies that combine fluids and vasopressors are better individualized strategies.

Evidence supports that usual care is just as good as protocolized care.

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Increased mortality from the sepsis bundle was driven by delayed in antibiotics and not fluid bolus. Why?

Volume resuscitation is a lot more than just "filling the tank".

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Making the case of Individualized boluses.

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They key to determine who needs fluid... fluid responsiveness.

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Using an individualized approach with fluid responsiveness should be the key to giving fluids in sepsis.

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