My interpretation and takeway of CLOVERS being admittedly a "dry physician". nejm.org/doi/full/10.10…1/ This was the trial of mostly mildly septic pts (<20% vasopressor use at rnd, ) most of whom would not get admitted to ICU in many countries. Having said this, it is very important to see them so early in the disease process, not after litres of resus fluids.
Nov 27, 2022 • 4 tweets • 3 min read
1/ We want to improve haemodynamic management and fluid stewardship at my place (Honvédkórház ICU, Budapest, Hungary).
See examples of study metrials below and please tear them apart as we want to improve them further.
The first one was made to avoid reflex fluids in oliguria. 2/ Inspired by #HR2022@AndromedaShock@khaycock2@ThinkingCC@msiuba @PulmCrit@iceman_ex@icmteaching and many more. Thank you all!
The rest of the pages are about haemodynamic profiling.
The point I would like to put out to debate complemented by a case is regarding the resolution of POCUS in some clinical scenarios detecting fluid overload.
2/ Basically, if your IVC is dilated, already -> VEXUS 1
For VEXUS 3, it seems to me, you need to have a significant cardiac abnormality and/or kidney injury (often to the point requiring RRT).
