Title: Pellerito's Corner - March 2015
Author: Peter Pellerito, President & CEO
Facility: ImaCor Inc. Garden City NY

This month, our discussion on fluid overload and the management of sepsis continues as it's clear that these issues remain at the forefront of critical care opportunities to impact quality metrics and cost.

In a video interview, Anders Perner MD PhD points out that we still have much to learn about appropriate fluid administration including volume, timing, and types of fluids. Physicians recognize the need for swift resuscitation but do not have the information they need to make appropriate decisions.

While Perner addresses the difficulties of fluid administration, Marik proposes a new approach to resuscitation in his literature review. In light of the ARISE and ProCESS studies, which found no benefit from Early Goal Directed Therapy (EGDT), Marik suggests an individualized approach and more conservative fluid strategy (more on that in Harold Hasting's commentary).

With ambiguity around fluid management of septic and other severely ill patients, hTEE programs for advanced hemodynamic management provide the only solution by directly indicating whether or not a patient is overfilled, if they are responsive to fluid and if they should receive more. Navicent Health's patient algorithm for hTEE, presented by Amy Christie MD during the 44th Annual SCCM Congress, provides guidelines and steps to follow for its critical care team. It demonstrates how hospitals can standardize and improve their care of patients who are at risk for severe complications such as fluid overload.

I anticipate much more on this at the 35th ISICEM next week. If you're attending, I look forward to meeting you and hearing your thoughts on the latest developments in fluid therapy and sepsis.