The edition · Emergency & Critical Care
Early vasopressors with less fluid in septic shock: no more days alive, less pulmonary oedema
ARISE FLUIDS settles a resuscitation question by a draw, cold-stored platelets last three weeks, family members of sepsis survivors stay unwell, and how far bedside ultrasound can be trusted for the right ventricle in PE.
The edition in brief
ARISE FLUIDS randomised 1,000 emergency department patients with septic shock to restricted fluid with early vasopressors or more fluid with later vasopressors. Days alive and out of hospital at 90 days were identical (median 76 in both; difference 0.0, 95% CI −2.7 to 2.7), but pulmonary oedema was less common with the restrictive approach (0.6% vs 5.0%). The CHIPS trial found platelets stored cold for up to 21 days were non-inferior to room-temperature platelets for bleeding control in 989 cardiac surgery patients, which could ease shortages, though re-exploration was more frequent. In 94 sepsis survivors and their next of kin, about 42% of caregivers had mental health problems a year after discharge, strongly linked to the patient's own mental symptoms. Emergency physician point-of-care ultrasound was 77% sensitive and 86% specific for right ventricular dysfunction in pulmonary embolism compared with formal echocardiography, performing better when dysfunction was moderate to severe.
Platelets stored cold for up to 21 days controlled surgical bleeding as well as standard platelets
Platelets stored cold for up to three weeks were as effective as standard platelets for surgical bleeding, which could widen access.
Four in ten family members of sepsis survivors still had mental health problems at a year
Ask about the caregiver's mental health when following up an ICU sepsis survivor.
Bedside ultrasound found right ventricular strain in PE with moderate accuracy
Bedside ultrasound reliably flags moderate to severe right ventricular strain in PE, but a normal scan does not rule out milder dysfunction.
Reassess after every fluid bolus in septic shock
Treat each fluid bolus in septic shock as a test, and move to a vasopressor when it stops helping.
ARISE FLUIDS: less fluid and earlier vasopressors gave the same outcome with less pulmonary oedema
Consider early vasopressors with restricted fluid in septic shock; outcomes were the same and pulmonary oedema less frequent.
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