Adding to point 1. below :
Why isn't restoring volume that is lost interstitially necessary? Couldn't ignoring this lead to delay in achieving adequate perfusion of the metabolically active tissue which is represented by the ideal weight , (and perhaps premature use of pressors)? Dale Brochis BA Gainsharing Project Coordinator Case Management Department Robert Wood Johnson University Hospital at Rahway 865 Stone Street Rahway, NJ 07065 732-499-6217 Office / 732-428-2108 Cell [email protected] <mailto:[email protected]> From: Brochis, Dale. Sent: Friday, May 30, 2014 9:14 AM To: 'Barnes-Daly, Mary Ann'; 'Kelsey K. Solano'; '[email protected]' Subject: RE: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg Two issues here - 1. maintaining volume within cardiovascular system -which includes adipose tissue 2. flushing of metabolically active tissue. So which volume measure is more important/ more dangerous if neglected? Dale Brochis BA Gainsharing Project Coordinator Case Management Department Robert Wood Johnson University Hospital at Rahway 865 Stone Street Rahway, NJ 07065 732-499-6217 Office / 732-428-2108 Cell [email protected] <mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Barnes-Daly, Mary Ann Sent: Thursday, May 29, 2014 6:19 PM To: 'Kelsey K. Solano'; '[email protected]' Subject: Re: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg Every recommendation that I have seen or heard, most recently from the faculty on the SSC, is to go with actual body weight. Remembering that adipose tissue is highly vascular and contains a large amount of water and that the main 2 reasons for the fluid bolus are 1. Vasodilation reducing perfusion pressure and more importantly 2. Capillary leaking - and with all those miles (literally) of leaky capillaries obese patients have a very high propensity for intravascular volume depletion. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Kelsey K. Solano Sent: Wednesday, May 28, 2014 7:05 AM To: [email protected] Subject: [Sepsis Groups] Fluid Bolus in pts. with weight > 200 kg I am wondering whether there are any recommendations regarding fluid resuscitation in patients weighing >200 Kg? Our physicians have expressed concern about the recommended fluid bolus for patients who are > 200 Kg and potential for CHF exacerbations. Are there any resources that address this concern or any modifications for this patient population? Also, is it always recommended to go with 30 ml/kg based on current weight or should we be calculating ideal weight when determining bolus volume? Currently we are using the patient's actual weight on admission for bolus calculations. Any clarifications regarding the fluid bolus would be greatly appreciated. Thanks, Kelsey K. Solano Sepsis Coordinator Email: [email protected] Office: 574-335-2438 This e-mail and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to whom they are addressed. This communication represents the originator's personal views and opinions, which do not necessarily reflect those of Robert Wood Johnson University Hospital at Rahway. If you are not the original recipient or the person responsible for delivering the e-mail to the intended recipient, be advised that you have received this e-mail in error, and that any use, dissemination, forwarding, printing, or copying of this e-mail is strictly prohibited. If you receive this email in error, please immediately notify [email protected].
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