If you've ever wondered about the sepsis patient you're treating, whose BP starts dropping after IV fluids, this is the talk for you. John Myburgh gave this fantastic lecture during SMACC 2013, and when such a comment is uttered on stage, you've got to sit up and listen.
The talk's about resuscitation and catecholamines, and it challenges what we think is dogma in resuscitation.
We used to give tons of fluids to hypotensive septic patients, and then give dopamine to boost the blood pressure. We may not give much thought to the fluid therapy as well as the vasopressor/inotrope of choice, as the endpoint we're familiar with is a normal blood pressure. Now, more and more critical care physicians are turning to smaller volume resuscitation in sepsis, and there are good reasons for that. (As a side note, the FEAST trial appear to be just the right fuel for this debate. Though this is a trial involving paediatric patients in resource poor Africa, its implications are far reaching! In an editorial, John had called for the use of fluids as if they were drugs... think twice before hanging up the next bag!)
What about the vasopressors then? John is both an intensivist and a professor in catecholamines research. He will give you a fascinating history on catecholamines and vasopressor use. Also, he will introduce some concepts (will be new to some but is known since Guyton's time) regarding the venous circulation, MSVP, and how catecholamine physiology works to improve cardiac output . This talk is bound to challenge and broaden your views on the use of vasopressors and inotropes.
Here is the talk...